CMS Expands Medicare Advantage Audits to All Eligible Contracts

• •CMS will audit all eligible Medicare Advantage contracts each payment year.
• •The expansion aims to address $17 billion in annual Medicare Advantage overpayments.
• •CMS is adding resources to expedite audits from 2018 to 2024.

On October 17, 2026, the Centers for Medicare & Medicaid Services (CMS) announced a major expansion of its auditing strategy for Medicare Advantage (MA) plans. This new approach will involve auditing all eligible MA contracts for each payment year and adding resources to expedite the completion of audits from 2018 to 2024. CMS aims to address significant overbilling issues, with estimates suggesting that unsupported diagnoses lead to $17 billion in annual overpayments. The audits will verify the accuracy of diagnoses used for risk-adjusted payments, which are crucial for determining payments for Medicare patients. The expansion reflects a commitment to combat fraud, waste, and abuse in federal healthcare programs. This change follows a history of delays in completing previous audits, with the last major recovery of overpayments occurring after the audit of payment year 2007. The new strategy is expected to enhance oversight and accountability in the Medicare Advantage program.