Medicare Advantage Audits - Why are insurance companies are fighting against them?

September 5, 2019

I've always been fascinated by the Medicare Advantage plans and how insurance providers are able to create these plans at such an inexpensive price for the insured.  they must be using creative ways to save costs and ensure they receive some compensation from the government.

There is currently a battle over the Medicare Advantage audits in our health insurance system. 


The audits, called "risk adjustment data validation," have created paranoia among insurers for years. The federal government created the audits as a way to make sure insurers' records of patients' diagnoses matched up to their medical records.

Medicare Advantage insurers have exaggerated diagnoses as a way to get higher payments from the federal government, costing taxpayers billions of dollars over the past decade.


It is quite clear that these insurance companies are attempting to maintain control over how and when the government can look into the requests they are making for additional funds.  The government should have complete control over how these audits are completed because they control fraud that would affect them. But insurance companies have more incentive to maintain control over watch funds they receive from the government.


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Keaton Marks License #0L47187

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