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Medicare Risk Adjustment Data Validation Program

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About the Program

The Medicare Risk Adjustment Validation Program was created to identify and correct past improper payments to Medicare providers and implement procedures to help the Centers for Medicare & Medicaid Services (CMS), Medicare carriers, fiscal intermediaries and Medicare Administrative Contractors (MACs) implement actions that will prevent future improper payments. Communication about audit results and trends leads to continuous process improvement and more accurate payments, and helps plan sponsors correct issues in a timely manner.

Who We Are

The Center for Program Integrity (CPI) serves as CMS' focal point for all national and statewide Medicare and Medicaid programs and Children's Health Insurance Program (CHIP) integrity fraud and abuse issues. Identifying and preventing improper payments in the Medicare Advantage (Part C) and Prescription Drug (Part D) is central to that work. CMS/CPI manages the Medicare Risk Adjustment Validation Program as a component of that goal.

Spotlight: Audits, Appeals, Resources.
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