CMS Enforcement to Provider Risk: The Downstream Impact of RADV Audits

This episode covers CMS enforcement activity and the downstream impact of Risk Adjustment Data Validation (RADV) audits on healthcare providers participating in Medicare Advantage.

PYA experts explain how Medicare Advantage payments flow from CMS to health plans and providers, how risk adjustment drives reimbursement, and why provider documentation plays a critical role in compliance. The discussion also outlines current audit trends, documentation requirements, and practical strategies providers can use to reduce risk and respond to increasing regulatory scrutiny.