The Centers for Medicare and Medicaid Services (CMS) announced on May 22, 2025, a significant expansion of its auditing efforts for Medicare Advantage plans. CMS will immediately begin auditing all eligible Medicare Advantage contracts for each payment year in all newly initiated audits.
The agency will also invest additional resources to expedite the completion of audits for payment years 2018 through 2024. This expansion includes collaboration with the Department of Health and Human Services Office of Inspector General to recover 'uncollected overpayments' identified in past audits.
Publicly traded healthcare companies, including Elevance Health, are impacted by this increased regulatory scrutiny. This move signals a stricter enforcement environment for Medicare Advantage plans, potentially leading to financial recoveries by the government and increased compliance costs for insurers.
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