Medicare Advantage feels like the Wild West — don’t wander off the trail. Download our special report

In May CMS dropped one of the biggest announcements since the advent of ICD-10: An exponential increase of Medicare Advantage (MA) risk adjustment audits. The agency planned to hire 2,000 coders, ramp up its tools with AI and tech, and launch a full-on audit storm.

We were all braced for extrapolated, multi-million-dollar recoupments of every MA plan in the nation, per CMS.

And then, the other shoe dropped.

On Sept. 25, a TX district court vacated the 2023 Risk Adjustment Data Validation (RADV) rule. The court ruled that the CMS rule did not give adequate notice nor comment period to a groundbreaking piece of regulation that would have held MA plans to a higher standard of code validation.

The foundation for CMS’ expanded MA audits, cracked.

If that wasn’t enough, the very next day, a suspiciously well-timed CMS press release dropped, indicating that MA has never been healthier, and plan member premiums would be more affordable in 2026.

So where does this leave us—besides a front-row seat to the Wild West show?

Download The Wild West of Medicare Advantage: Surviving in an Age of Regulatory Uncertainty for answers.

This report arms healthcare mid-revenue cycle leaders with the information and tools to get started on revenue and compliance strategy.