On September 25, 2025, the U.S. District Court for the Northern District of Texas issued a significant decision vacating a rule issued by the Centers for Medicare & Medicaid Services (“CMS”) that ...

CMS will extrapolate RADV audit findings beginning with payment year (“PY”) 2018, and will not extrapolate RADV audit findings for PYs 2011 through 2017, though it will continue to collect the ...

Medicare Advantage (MA) plans could face tougher risk adjustment audits after the Biden administration finalized a highly anticipated regulation Monday. The Centers for Medicare & Medicaid Services ...

A new overhaul to Medicare Advantage (MA) risk adjustment audits will still leave billions on the table if the Biden administration doesn’t go further, a group of experts contend. Several experts ...

The CMS has provided a long-awaited update on how it plans to approach Medicare Advantage audits, five months after a federal judge threw a wrench in the agency’s plan to drastically expand the money ...

The RADV audit changes have drawn most of the ire from insurers, with AHIP saying CMS' approach "is improper and should be withdrawn." CMS proposed to apply the regulation retroactively to hundreds of ...

The 2023 final rule on Medicare Advantage RADV audits is a glass both half empty and half full. Risk adjustment is hugely important in Medicare Advantage (MA). Risk adjustment is intended to adjust ...

A federal judge has thrown out a Biden-era rule that would have clawed back billions of dollars in overpayments from Medicare Advantage insurers in a major win for the industry. On Thursday, Judge ...

The MarketWatch News Department was not involved in the creation of this content. LOUISVILLE, Ky., Aug. 14, 2025 /PRNewswire/ -- RAAPID, a leading provider of AI-powered risk adjustment solutions, ...

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