What happens if discrepancies are found during a RADV audit?

When discrepancies are found during a RADV audit, it is significant because it typically indicates that the submitted information does not align with the medical records or other documentation provided. As a result, plans may be held accountable for any overpayments they have received based on this incorrect data. The audit process aims to ensure that the risk-adjusted payments made to healthcare plans reflect the true needs of the populations they serve. When discrepancies are identified, it can lead to plans being required to repay those overpayments to the Centers for Medicare and Medicaid Services (CMS) or face additional penalties for non-compliance with reporting requirements.

This accountability measure emphasizes the importance of accurate data reporting and the integrity of the information submitted by health plans. It ultimately ensures that resources are allocated correctly and that funds are being used effectively to serve beneficiaries. The implications of the audit findings can exert pressure on plans to improve their data accuracy and compliance practices to avoid similar situations in the future.