CMS Audit of Medicare Advantage Plans for 2018-2024 Dates of Service

On May 21, 2025, the Centers for Medicare & Medicaid Services (CMS) announced significant changes to its Medicare Advantage Risk Adjustment Data Validation (RADV) auditing efforts. Starting immediately, CMS is auditing all eligible Medicare Advantage contracts for each payment year going back to 2018.

Premera will be reaching out to provider offices to request historical information related to patients selected by CMS for each payment year reviewed. These will be small volume, urgent requests coming from Premera. The urgency is due to the compressed review period required by CMS. We appreciate your support as we work through this accelerated audit cycle. If you don’t receive a letter, no action is needed. Read the CMS press release for more details.