CMS Administrator Calls Medicare Advantage Oversight a Top Priority, Describing the Program as Vulnerable to Abuse

Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz told attendees at the Better Medicare Alliance annual meeting on September 23 that strengthening oversight of Medicare Advantage is "one of our top priorities," and that the program has been "vulnerable to weeds and overgrowth."

Oz said patients have "paid the price both financially and physically" when the program falls short, and he described tighter oversight as essential to preserving Medicare Advantage as a sustainable option for beneficiaries.

The administration has taken several oversight steps. CMS has increased audit activity targeting Medicare Advantage plans for potential overpayments and finalized tighter guardrails on health risk adjustment, the payment mechanism that compensates insurers based on the diagnoses reported for their enrollees. Federal auditors have repeatedly found cases where plans submitted diagnosis codes that lacked support in medical records.

At the same time, CMS finalized 2027 Medicare Advantage payment rates roughly 5 percent higher than 2026 levels, extended several industry-favorable provisions in the annual payment rule, and withdrew certain marketing disclosure requirements that had been proposed by the prior administration.

More than 35 million people are currently enrolled in Medicare Advantage plans, which account for more than half of all Medicare beneficiaries and a significant share of total Medicare spending.