Who conducts the on-site RADV audits?

The correct answer highlights that the Centers for Medicare & Medicaid Services (CMS) employs contractors to perform the audits as part of the Risk Adjustment Data Validation (RADV) process. These contractors are specialized entities that CMS selects to ensure that audits are conducted objectively and with expertise in risk adjustment methodologies and compliance requirements. This approach helps maintain consistency and reliability in the audit process, allowing for an independent review of the data submitted by health plans.

Using contractors also facilitates a separation of duties, ensuring that the health plans themselves are not reviewing their own data, which could lead to conflicts of interest. By relying on external contractors, CMS can leverage specialized knowledge and skills that may not reside within the agency, enhancing the integrity and effectiveness of the RADV audits. This helps to ensure that the audits effectively validate the accuracy of claims and support the ongoing integrity of the risk adjustment program.