Patent RADV Audit Acceleration Algorithm via IP Moat Construction
- Organization
- Centers for Medicare & Medicaid Services (CMS)
- Sector
- CMS-approved RADV audit contractors and Medicare Advantage audit firms
- Location
- United States
Source reference
Executive summary
Current state
CMS faces GAO-mandated acceleration of RADV audits to recover $23.7B in improper Medicare Advantage payments but lacks operational capacity and documented execution plan, creating immediate vendor opportunity for audit automation and recovery systems.
Market catalyst
CMS lacks documented plan for expediting RADV audits despite GAO mandate and $23.7B improper payment exposure, creating immediate need for audit acceleration methodology that doesn't exist at required scale
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