CMS has granted Elevance Health’s request for more time to resolve the ongoing dispute over Medicare Advantage risk adjustment data reporting, pushing back a possible start date on enrollment sanctions by two months.
In a March 18 statement, Elevance said CMS extended the date that sanctions could be imposed from March 31 to May 30, 2026. The company said it continues to engage in “a productive dialogue” with CMS as it works to address the issues raised in the agency’s original notice in late February.
CMS also told Elevance that several of its MA plans named in the initial letter would be exempt from possible sanctions, including employer group retiree plans and 11 specific contracts.
“This matter does not impact how we serve members today or affect member coverage, benefits, or care,” Elevance said in its statement. “Our focus remains on delivering high-quality coverage and service to our Medicare Advantage members.”
The extension comes after CMS issued an enforcement notice threatening to suspend enrollment into Elevance’s MA prescription drug plans over what the agency characterized as “substantial and persistent noncompliance” with risk adjustment data submission requirements. CMS alleged that from November 2018 through October 2025, Elevance submitted data corrections for unsupported diagnosis codes via encrypted external USB flash drives rather than the required electronic systems, and that the company continued to certify the accuracy of its risk adjustment data submissions during that period despite knowing that unverified diagnosis codes had not been corrected through required channels.
In March, Elevance CFO Mark Kaye pushed back on the allegations and said the company views the dispute as a policy and payments disagreement rather than a data submission issue.
“This is not simply a data submission issue. We view this as a broader policy and payments dispute about how retroactive corrections should be treated under the risk-adjustment framework that was in place during that period,” he said. “This is a disagreement over the interpretation of policy. It’s not an unwillingness to correct inaccurate data.”
In a securities filing, Elevance previously said it revised its practices in April 2023 following additional regulatory guidance from CMS, and that the alleged noncompliance relates to claims from before that date.
Elevance had 1.9 million MA members as of Feb. 1.
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