Washington, D.C. (May 22, 2025) — The Alliance of Community Health Plans (ACHP) released the following statement in response to an announcement from the Centers for Medicare & Medicaid Services (CMS) on risk adjustment audits in the Medicare Advantage program:
“A one-size-fits-all approach to risk adjustment is at best inadequate and at worst a frivolous waste of taxpayer dollars. RADV audits are an important program integrity tool to recover improper payments and deter aggressive behavior. Random risk adjustment audits, rather than audits targeted on plans with track records of coding abuses, will waste precious time and dollars. Health plans appropriately coding should not be punished with expensive and time-consuming audits that cost more to conduct than they return to the Medicare Trust Fund. Our MA For Tomorrow framework seeks to limit the widely reported exorbitant risk adjustment practices we’ve seen from the large national plans. We call on CMS to advance a risk adjustment system that limits opportunities to game for financial gain and shifts the focus back to high-quality care instead of calculated coding.”
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About ACHP
The Alliance of Community Health Plans (ACHP) represents the nation’s best local, nonprofit health plans, providing high-quality coverage to tens of millions of Americans in 40 states and D.C. ACHP is the only national organization advancing a unique partnership model of coverage and care that fosters a truly competitive market.
We believe Americans deserve the best health care in the world. Our members are on the ground in your communities, delivering innovative and competitive coverage. ACHP’s model brings together clinicians and health plans to deliver value for patients, employers and taxpayers.
