CMS Expands Audits to Crack Down on Medicare Advantage Overpayments

Massive Medicare Audit Push Could Spell Trouble for Nursing Home Operators

The Centers for Medicare & Medicaid Services (CMS) is launching a sweeping crackdown on billing practices across all Medicare Advantage (MA) plans—an aggressive move that could ripple through the nursing home industry and reshape how skilled nursing operators navigate federal reimbursement. In a major policy shift announced Wednesday, CMS revealed plans to dramatically scale up audits of all MA plans to recover billions in alleged overpayments. …

CMS expands audits to crack down on Medicare Advantage overpayments

The agency said it would increase the number of MA plan audits and complete its backlog of reviews by investing in technology and growing its medical coding workforce.

Trump, building on Biden policy, to speed up audits of Medicare Advantage insurers

Centers for Medicare and Medicaid Services to hire nearly 2,000 coders to conduct audits to confirm diagnoses used for payment are backed by medical records.

UnitedHealth drops after announcement that regulator will increase Medicare Advantage audits

UNH had already fallen more than 5% on Wednesday after a report from The Guardian....

CMS Audit Crackdown Triggers Data Intelligence Race: Black Book Reintroduces 2025's Top-Rated Payer IT Vendors - European Business & Finance Magazine

New rules ignite a surge in payer demand for data platforms that support RADV readiness, Stars forecasting, and member retention analytics. WASHINGTON, DC / ACCESS Newswire / May 23, 2025 / In the wake of this week’s Centers for Medicare & Medicaid Services (CMS) announcement mandating annual RADV audits for all Medicare Advantage (MA) plans, health insurers face unprecedented urgency to modernize their audit readiness, risk adjustment, and qual…

CMS to expand audits of MA plans

The Centers for Medicare & Medicaid Services May 21 announced it will immediately begin annual audits of all Medicare Advantage plans and work to clear a backlog of audits from 2018 through 2024. The audits focus on risk adjustment data validation to confirm to CMS that diagnoses submitted by Medicare Advantage plans for determining risk adjustment payments are supported by medical records. CMS expects to complete the backlog by early 2026. The …