CMS flagged ~$93.5B in improper payments across 5 programs. A Texas court just vacated the rule designed to claw it back. This is not a compliance story. It is a market structure story.
Medicare Advantage hit 6.09% improper payment rate, within target. Sounds fine. But that measure captures documentation gaps, not systematic risk-score inflation worth tens of billions more.
RADV was supposed to fix that. The 2023 Final Rule would have turned it into a multibillion-dollar recovery engine. Plans sued. Northern District of Texas vacated key portions on Sept 25, 2025.
Here is the insight: litigation that disrupts a mandate multiplies demand for expertise. Both sides now need better statisticians, better sampling, and better chart review than a year ago.
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