CMS press release:
May 21, 2025
CMS Rolls Out Aggressive Strategy to Enhance and Accelerate Medicare Advantage Audits
Agency Will Begin Auditing All Eligible Medicare Advantage Contracts Each Payment Year and Add Resources to Expedite Completion of 2018 to 2024 Audits
Today, the Centers for Medicare & Medicaid Services (CMS) announced a significant expansion of its auditing efforts for Medicare Advantage (MA) plans. Beginning immediately, CMS will audit all eligible MA contracts for each payment year in all newly initiated audits and invest additional resources to expedite the completion of audits for payment years 2018 through 2024.
“We are committed to crushing fraud, waste and abuse across all federal healthcare programs,” said Dr. Mehmet Oz, CMS Administrator. “While the Administration values the work that Medicare Advantage plans do, it is time CMS faithfully executes its duty to audit these plans and ensure they are billing the government accurately for the coverage they provide to Medicare patients.” ...
Currently, CMS is several years behind in completing these audits. The last significant recovery of MA overpayments occurred following the audit of payment year (PY) 2007, despite federal estimates suggesting MA plans may overbill the government by approximately $17 billion annually. The Medicare Payment Advisory Commission (MedPAC) estimates this figure could be as high as $43 billion per year. CMS’s completed audits for PYs 2011–2013 found between 5% and 8% in overpayments. ...
Department of Government Efficiency
@DOGE
Great work by @DrOzCMS and @CMSGov to begin cracking down on overbilling by Medicare Advantage plans.
The government is 7 years behind on its required audits of these plans, but will now catch up on all audits by the end of this year. These audits should result in billions of taxpayer dollars returned to the Treasury, as various reports estimate MA overbilling at between $17B and $43B per year.
10:27 PM · May 21, 2025
