Capture RADV Audit Acceleration via Contingency Fee Model
- Organization
- Centers for Medicare & Medicaid Services
- Sector
- Medicare Advantage insurers with high improper payment rates
- 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
CMS has $23.7B in improper payments and a September 2026 GAO deadline for RADV audit completion, but lacks processing capacity due to audit backlog and insufficient corrective action plans rejected by GAO oversight.
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