GAO: Medicare Advantage Made $23.7 Billion in Improper Payments in FY 2025, and No Comprehensive Fraud Risk Assessment Exists

The Government Accountability Office published a report on July 21, 2026, finding that Medicare Advantage organizations made $23.7 billion in improper payments in fiscal year 2025. The report, GAO-26-107946, is the first in a planned series examining program integrity in both the VA Community Care program and Medicare Advantage. GAO found that the Centers for Medicare and Medicaid Services has not developed a comprehensive fraud risk assessment for Medicare Advantage, a step that federal standards for program integrity treat as foundational. Without such an assessment, the government lacks a systematic way to identify, rank, and target the highest-risk fraud vulnerabilities in the program. GAO also noted that CMS's estimated improper payment rate for Medicare Advantage has remained essentially flat rather than declining. The report stops short of attributing the persistent error level to any single cause, but its findings land as scrutiny of Medicare Advantage payment accuracy continues to build. CMS has expanded its Risk Adjustment Data Validation audits to cover all Medicare Advantage contracts annually, and OIG has flagged billions in unsupported diagnosis codes in recent separate reports. For enrollees, improper payments in Medicare Advantage generally reflect overpayments from the government to insurers, not errors in individual claims. Still, the broader accuracy of plan payments can shape the benefits and premiums plans are able to offer. GAO directed recommendations to both CMS and the Department of Veterans Affairs to develop comprehensive fraud risk assessments for their respective programs.