22 May Medicare Advantage Compliance Is Entering a New Phase. Health Plans Need Better Data Foundations.
Top Takeaways • Medicare Advantage oversight is intensifying as CMS and federal regulators place greater scrutiny on audit readiness, risk adjustment accuracy, and data integrity. • Risk adjusted data validation is becoming more critical as plans prepare for increasing compliance expectations and operational complexity.• Fragmented data environments create compliance risk when clinical, claims, and encounter data cannot be trusted or validated consistently.• Audit ready data infrastructure is becoming essential as health plans face growing pressure to support...
