STAT+: Federal judge vacates rule that would have ramped up Medicare Advantage audits

A federal judge on Thursday vacated a Biden-era rule that would have allowed the government to intensify its audits of private Medicare plans and recoup billions of dollars in overpayments over the next decade.

Judge Reed O’Connor of the Northern District of Texas granted health insurer Humana’s motion for summary judgment in its lawsuit challenging a Centers for Medicare and Medicaid Services (CMS) final rule from 2023.

The rule sought to increase so-called risk adjustment data verification (RADV) audits of Medicare Advantage plans. These audits verify that the diagnoses Medicare Advantage plans record for their members are supported by those members’ medical records.
https://www.statnews.com/2025/09/25/federal-judge-vacates-medicare-advantage-audit-rule/?utm_campaign=rss