Build Medicare Advantage Improper Payment Dataset via FOIA Scraping
- Organization
- Centers for Medicare & Medicaid Services
- Sector
- Medicare Advantage insurers and reinsurers
- 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 collects but doesn't systematically publish detailed RADV audit findings showing which diagnosis codes, providers, and MA plans have highest improper payment rates, creating information asymmetry that insurers desperately need for compliance optimization.
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