Audit Uncertainty Lingers for Medicare Advantage Insurers

In September 2025, the Biden administration's plan to intensify audits of Medicare Advantage insurers is showing signs of stalling. Back in May 2022, the administration had announced a goal to hire 2,000 medical coders by September 1st to scrutinize the billing practices of private insurers under the fast-growing federal Medicare Advantage program.

However, as of early September 2025, there is no evidence that the government has been able to meet this hiring target. The Centers for Medicare and Medicaid Services (CMS) has not posted job listings or confirmed progress towards the goal, and industry insiders warn that the federal government may struggle to compete with private-sector demand for skilled coders.

The stakes are significant, as Medicare Advantage is expected to channel over $500 billion to insurers this year. CMS has projected potential clawbacks of $4.7 billion over the next decade from audit findings, but without adequate staffing, the agency's timeline for clearing backlogs from 2018 through 2024 could be slipping.

While private insurers argue that Medicare Advantage offers better benefits and reflects legitimate risk-based pricing, critics have flagged the urgent need for reform, citing an estimated $84 billion in excess payments versus traditional Medicare. Until CMS confirms its next move, insurers may face a longer runway before audit penalties bite, but the overhang of uncertainty is not going away.