Create RADV Audit Methodology Patent via Regulatory Void
- Organization
- Centers for Medicare & Medicaid Services
- Sector
- Healthcare audit firms and Medicare Advantage compliance vendors
- Location
- Location unspecified
Source reference
Executive summary
Current state
CMS faces GAO pressure to expedite RADV audits and conduct comprehensive fraud risk assessment for Medicare Advantage, with $23.7B in improper payments and a September 2026 deadline creating a compliance gap that requires third-party intervention.
Market catalyst
GAO has mandated 'leading practices standard' for comprehensive fraud risk assessment in Medicare Advantage, but CMS has no defined methodology to meet this requirement, creating a regulatory void where the first entity to patent a compliant methodology becomes the de facto standard.
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