A Guide to Navigating the Federal Push on Risk Adjustment Data Validation (RADV) Audits

As part of its push to eliminate alleged fraud, waste, and abuse within the Medicare Advantage program, the Centers for Medicare and Medicaid Services (CMS) announced in May of 2025 its intent to complete RADV audits for payment years 2018-2024 by early 2026.

This announcement places significant burdens and risk on health care industry participants—and particularly health plans. Health plans need to mobilize resources in the short term to comply with audit requests and develop a legal and compliance strategy to mitigate risk to the organization. They also need to prepare for the possibility that the audits could lead to near term requests from the government for significant financial recoveries or other government enforcement actions, if audit results do not support the initial codes submitted.

This webinar will provide critical strategic guidance for industry participants who are actively undergoing (or proactively preparing for) RADV audits. This includes advice on:

• How to efficiently and effectively respond to incoming RADV audit requests
• How to preserve appeal rights and opportunities to push back on adverse audit findings
• How to assess and mitigate risks (financial and otherwise) from RADV audits, and to prepare for any subsequent government action or requests for recovery related to such audits.

CLE Credit
This program is pending CLE credit in CA, CO, IL, NY, and TX. Credit hours are estimated and subject to each state’s approval and credit rounding rules. We will apply to have this program accredited in other jurisdictions upon request. CLE credit is only available for attendance at the live webinar. CLE credit is not available for viewing this program on-demand.