Medicare Risk Adjustment Data Validation Program

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About the Program

The Medicare Risk Adjustment Validation Program is CMS' primary way to address improper overpayments to Medicare Advantage Organizations (MAOs). During a RADV audit, CMS confirms that any diagnoses submitted by an MAO for risk adjustment are supported in the enrollee's medical record.

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.

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Page Last Modified:
01/30/2023 01:44 PM