Why Data Scrubbing Is the Missing Layer in Delegation Audit Defensibility
Why delegation audit defensibility is now a leadership issue Delegation audit defensibility used to be a compliance team concern. Today, […]
Audit & Monitoring
How to Standardize Delegate Data Submissions for CMS Program AuditsÂ
For health plans, CMS audits do not begin with documentation. They begin with data. To ensure accuracy, it’s often beneficial
Why CMS audits are designed to test operations, not just documentation
For years, health plans treated CMS audits as documentation exercises. If policies looked current, files appeared complete, and evidence arrived
2026 CMS Program Audit Update: What Plans Must Do To Align
What Changed for 2026: Key Updates from CMS The 2026 audit update from CMS brings a fundamental shift in audit
2026 CMS Program Audit Countdown: How Health Plans Can Prepare Now
The audit clock has already started CMS Program Audits follow predictable patterns, but most health plans still treat them as
Internal Audit: Why Health Plans Can’t Rely on Generic Internal Audit Tools
Why most internal audit tools don’t work as expected for health plans Every year, CMS program audits trigger millions in
The 2025–2026 CMS Program Audit Calendar for Health Plans: Key Deadlines and How to Prepare
The CMS Program Audit Calendar for Health Plans is more than a timeline; it’s a test of preparedness. CMS Program
How to Standardize Delegate Data Submissions for CMS AuditsÂ
Delegate oversight is a critical component of CMS audit compliance, yet challenges with inconsistent or delayed Universe file submissions often
CMS Audit Updates 2025: What Medicare Advantage Plans Need to Know
CMS has introduced key RADV audit updates that raise the bar for health plan accountability. This blog breaks down what payers need to know, including changes to sampling, extrapolation, and error rate calculations, and how to stay audit-ready. Learn how automation, data quality, and GenAI can help reduce risk and improve compliance with the new CMS RADV audit requirements.
CMS Reminder to Practice Vigilance Against Medicare Fraud, Waste and Abuse(FWA)
On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending