CMS Accelerates RADV Audits: What Medicare Advantage Plans Need to Know Now

This week, the Centers for Medicare & Medicaid Services (CMS) dropped a seismic update that’s sending ripples through the Medicare Advantage (MA) landscape. In an aggressive push to enhance oversight, CMS will now audit every eligible MA contract for each payment year—a dramatic expansion from the previous ~60 audits annually.

Here’s what’s changing—and why it matters:

• Audit Volume Surge: Expect a jump from 35 records per plan per year to as many as 200, depending on plan size.

• Backlog Acceleration: CMS aims to clear the 2018–2024 RADV audit backlog by early 2026.

• Massive Workforce Growth: The audit team will expand from 40 to 2,000+ medical coders by September 2025.

• Technology-Driven Review: CMS will leverage AI to flag unsupported diagnoses more efficiently.

• Stronger Enforcement: Audit findings will continue to be extrapolated, increasing financial risk.

What does this mean for you?RADV audits are no longer a possibility—they’re a certainty. Medicare Advantage Organizations must rethink how they prepare, document, and respond. Internal teams, providers, coders, and billing partners need to align now to avoid costly consequences later.

Simply Compliance can help.

Whether you're navigating your first RADV audit or refining your existing compliance program, we help teams develop strategies that stand up to scrutiny.

Have questions about your audit readiness? Let’s talk about how to safeguard your compliance posture in this new era. Contact us today.