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Medicare Advantage

GAO Report Flags 23.7 Billion Dollars in Medicare Advantage Improper Payments and Calls for Stronger Fraud Controls

The Government Accountability Office found that Medicare Advantage improper payments hit an estimated 23.7 billion dollars in fiscal year 2025, representing about 6.1 percent of the program's outlays, while CMS has yet to complete a comprehensive fraud risk assessment.

By the Goodsurance editorial teamOctober 18, 2026

Medicare Advantage improper payments reached an estimated 23.7 billion dollars in fiscal year 2025, about 6.1 percent of the program's total outlays, according to a Government Accountability Office report published in July 2026. The figure is a CMS-produced estimate and encompasses overpayments, payments without adequate supporting documentation, and payments that did not fully comply with Medicare rules. It is not a finding that all of that sum was fraudulent.

The GAO reviewed program integrity controls across both the Department of Veterans Affairs Community Care program and Medicare Advantage. For the MA program, GAO found that CMS has catalogued three root-cause categories for improper payments, medical record discrepancies, administrative or process errors, and insufficient documentation. However, the report concluded that CMS's corrective action plans are not sufficiently detailed and do not include meaningful milestones for tracking progress. From fiscal years 2020 through 2025, CMS's reported improper payment rate for Medicare Advantage ranged from 5.42 percent to 10.28 percent, and GAO noted it has not declined over that span.

GAO found an estimated 23.7 billion dollars in Medicare Advantage payment errors in 2025. The government watchdog says CMS still needs a comprehensive fraud prevention plan.

More broadly, GAO found that CMS has not developed a comprehensive fraud risk assessment for the Medicare Advantage program, a step required under the Program Fraud Prevention Act of 2016. GAO recommended that CMS complete such an assessment and strengthen its corrective action planning. CMS agreed with certain recommendations and disagreed with others.

The report came out three months before Medicare's current open enrollment period for 2027 plans, which runs through December 7. CMS Administrator Mehmet Oz has separately described Medicare Advantage oversight as a top agency priority.

In plain words

Medicare Advantage is the version of Medicare run by private insurance companies. In 2025, the government found that about 23.7 billion dollars in Medicare Advantage payments did not follow all the rules. That is about 6 cents out of every dollar the program spent. A government watchdog called the GAO looked at this. They said the agency that runs Medicare, called CMS, still does not have a full plan to find and stop fraud. The GAO told CMS to make one. CMS agreed with some of those suggestions but not all. You can still change your Medicare plan during open enrollment, which runs until December 7.

Understand the basics first

Source: GAO
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