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CMS program audit readiness playbook

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Preparing for CMS Medicare Audits in 2026

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Medicare Advantage CMS audits 2026 digital-first readiness

CMS Medicare Audits: A digital-first approach

By 2026, CMS will audit all 550 Medicare Advantage plans annually. Manual audit prep will no longer hold up. Plans that still rely on spreadsheets and email chains will face higher error rates, costly corrective action plans (CAPs), lower Star ratings, and millions in avoidable revenue loss.

This whitepaper explains how health plans can future-proof compliance with a digital-first Universe Management System (UMS).

Why this matters now

  • Universal audits: Every MA plan will be audited annually by 2026
  • Compressed timelines: 15 business days to submit universes, leaving no room for manual rework
  • Increased financial exposure: Improper Medicare Advantage payments reached $31.7B in 2023. Each CAP costs $1–2M annually, while a one-star rating drop can wipe out $50–100M 

What you’ll learn

  • How manual universe management fails and exposes plans to operational and financial risks
  • What a digital-first audit readiness model looks like
  • Best practices and a step-by-step roadmap for implementation in under 120 days

Who should read this

  • Compliance officers seeking defensible, audit-ready universes
  • Medicare Audit leaders preparing for CMS’s universal audit expansion
  • Operations executives focused on efficiency, Stars protection, and reducing CAP costs
  • Delegation oversight teams managing risk from FDR submissions

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