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CMS Announces Significant Changes to RADV Auditing Efforts: Considerations and Next Steps for the Medicare Advantage Industry

On May 21, 2025, the Centers for Medicare and Medicaid Services (“CMS”) announced plans to substantially increase both the pace and the scale of Risk Adjustment Data Validation (“RADV”) audits of the Medicare Advantage (“MA”)...more

Key Trends in Dual-Eligible Health Insurance: Takeaways from the Medicarians Conference

Attorneys from Ropes & Gray attended the Medicarians Conference from March 31 to April 2, a premier event for Medicare Advantage (MA) and other health insurance brokers, agents, and distribution arms, as well as regional and...more

Medicare Advantage Fraud and Abuse: A Bipartisan Enforcement Priority

Early signs from the initial months of the Trump administration indicate that fraud and abuse enforcement related to the Medicare Advantage program (“MA”) remains a bipartisan focus, as evidenced by the recent statements from...more

OIG Issues Special Fraud Alert on Medicare Advantage Marketing Arrangements

On the heels of recent scrutiny of health care professional (“HCP”) arrangements with brokers and agents and Medicare Advantage Organization (“MAO”) arrangements with providers, including through the U.S. Department of...more

CMS Proposes Beneficiary Protection and Marketing Updates for Medicare Advantage and Part D Plans in 2026

On November 26, 2024, Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule revising the Medicare Advantage (“MA”) Program (Part C), Medicare Prescription Drug Benefit Program (Part D), Medicare Cost Plan...more

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