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RAAPID raises Series A funding with a Strategic “Industry Trifecta”. Read More

Day 1: The Changing Landscape of Medicare Advantage

The new MA reality. Why business-as-usual is now existential risk.

CMS is cracking down. OIG dropped new compliance guidance. DOJ settlements are hitting nine figures. V28 removed longstanding codes that drove years of revenue.

The January 2026 RADV memo, the OIG MA Industry Compliance Program Guidance, the $117.7M Aetna settlement, and three OIG audits with 81-91% error rates all happened within ten weeks. Each one rewrote a piece of what “compliant” actually means.

This kickoff session lays the foundation for what every risk adjustment leader, compliance officer, and finance executive needs to know about the new MA reality and what it demands of every plan still operating on old assumptions.

You’ll walk away with:

How CMS policy, OIG guidance, and DOJ enforcement are converging into a single new compliance standard
Why V28 isn’t just a model change but a fundamental shift in how risk capture works
What the $117.7M Aetna settlement and three March 2026 OIG audits actually signal
Why “documented” is no longer the same as “defensible”
How regulatory pressure is reshaping vendor selection and program design

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Panelists

Wynda was a RADV auditor when the program first started and maintains close contact with current CMS auditors. She brings a unique perspective on how CMS reviews documentation and what AI-powered tools will change about the audit process.

Chris brings over 30 years of healthcare operations expertise, including extensive experience in risk adjustment, revenue cycle management, and AI-powered coding solutions across industry-leading organizations. At RAAPID, he leads the implementation of advanced AI platforms that help healthcare organizations capture complete patient risk profiles while staying audit-defensible.

“CMS, OIG, and DOJ have all collectively said that if you can’t prove it, you won’t own it. This is the bring-the-receipts era. The organizations that survive over the next five years will be the ones that shift their mindset from workflows to bring the receipts.”

Who Should Attend

At organizations including Medicare Advantage plans, ACA health plans, ACOs, value-based provider groups, and third-party administrators

Chief Executive Officer (CEO)
Chief Financial Officer (CFO)
Chief Compliance Officer (CCO)
VP of Risk Adjustment
Director of Compliance
Risk Adjustment Manager
Coding Manager/Director
Revenue Cycle Director
Quality Assurance Director
Audit Manager
Operations Director

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