CMS Expands Medicare Advantage Audits to Combat Fraud, Waste, and Abuse

Medicare Advantage Audits Expansion

• 🎯 CMS is significantly expanding its auditing of Medicare Advantage plans.
• ⚠️ The agency acknowledges a backlog in audits between 2018 and 2024 and is allocating new resources to address it.
• 💰 This expansion is expected to put pressure on the stocks of major Medicare Advantage health insurers.

Impact on Insurers

• 📉 Shares of UnitedHealth, Cigna, Humana, and CVS Health are experiencing extended losses following the announcement.
• 💡 The move is somewhat surprising given the CMS administrator's previous advocacy for Medicare Advantage.

CMS Commitment and Strategy

• 🛡️ CMS Administrator stated a commitment to crushing fraud, waste, and abuse across federal healthcare programs.
• 💻 CMS plans to invest more in technology and increase the number of coders from 35 to 2,000 by September to expedite the auditing process.