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Increased Enforcement of CMS Risk Adjusted Data Validation Audits
August 28, 2025 @ 3:00 pm – 4:00 pm EDT
The Centers for Medicare and Medicaid Services (CMS) announced in late May that they will begin building out additional staffing to increase their efforts auditing risk-based payments made to Medicare Advantage (MA) plans with the stated goal of auditing all MA providers in the coming year. This is a marked increase from the approximately 60 audits they currently undertake.
As companies await these audits there are preemptive steps that can be taken to aid in preparedness, evaluate current coding gaps, and assess the size and scale of potential claw backs. This webcast will provide practical guidance for readiness, implementation, and ongoing monitoring of your company’s coding and reporting of risk-based payments.
1.0 CPE Credit in the field of Specialized Knowledge.
Learning Objectives
- Review the foundational concepts of RADV audits and explore the expanded scope and enforcement efforts currently being undertaken by CMS.
- Explore recent Medicare Advantage enforcement activity where the Department of Justice is scrutinizing potential areas of improper payment, fraud, waste and abuse.
- Examine practical steps for evaluating your company’s exposure, assessing risk, strengthening compliance, and managing medical record documentation.
- Discuss the recent CMS guidance and how that impacts your organization’s current efforts to comply.
CPE Information
Delivery: This webcast will be delivered via the BDO Online CPE Network
Prerequisites: None
Advanced Prep: None
Program Level: Basic
Information about CPE Eligibility
To receive CPE credit for participation in a BDO webcast program, you must respond to the occasional polls that appear throughout the program and be in attendance for a minimum of 50 minutes. You will receive an email notification following the program if you completed the necessary polls and qualified for CPE credit. This email will include instructions on how to access your CPE certificate.
Please Note: Per BDO USA’s CPE Compliance policy, CPE will not be issued for programs that fail to comply with the NASBA Standards, or to individuals who do not meet the attendance requirements. For example, a professional attending a webcast must respond to at least 3 polls per CPE credit.
For questions regarding CPE credit, please contact [email protected].
