CMS Watch
Risk adjustment news for HCC coders — CMS announcements, RADV updates, OIG reports, and FCA settlements, translated into what changes at your desk. Days, not quarters.
This week
OIG: $462M in Potential MA Overpayments Tied to Unsupported Acute Stroke Codes
OIG report A-02-23-01020, issued May 28, 2026, found that 100% of sampled acute stroke diagnosis codes in payment year 2021 were unsupported: physician-only records with no matching inpatient or outpatient hospital record for the same service year. OIG estimated $462 million in potential net overpayments and recommended a prepayment control. If you carry I63.x forward from a physician office note alone, that code is what CMS is being asked to block before it pays.
Kaiser's $556M FCA Settlement: What the Addenda and Query Allegations Mean for Working Coders
Five Kaiser Permanente affiliates agreed to pay $556 million to resolve False Claims Act allegations tied to MA risk-adjustment addenda and physician query programs. It's the largest MA risk-adjustment FCA settlement to date. Here's what the alleged mechanics mean for coders handling retrospective review.
CY2027 Rate Announcement: Audio-Only and Unlinked CRR Diagnoses Out of MA Risk Scores
CMS finalized two diagnosis exclusions for CY2027: audio-only telehealth encounters and unlinked chart-review records no longer count toward MA risk scores. Here's what changed, what didn't, and what coders need to audit before January 1, 2027.
550 Plans, Quarterly RADV Audits, Five Months to Submit: What the Jan 2026 CMS Memo Means at Your Desk
CMS's January 27, 2026 HPMS memo expands RADV from ~60 plans per year to 550+ plans on a quarterly schedule. Here's what changed operationally — submission window, sample sizes, records per HCC — and what coders should do before the next cycle.