The Centers for Medicare & Medicaid Services (CMS) has granted Elevance Health additional time to address alleged data reporting deficiencies tied to its Medicare Advantage programs, delaying potential enforcement actions while corrective steps are reviewed.
The development follows earlier warnings from CMS that it could suspend enrollment in Elevance’s Medicare Part D plans and restrict the company’s communications with beneficiaries if identified issues were not resolved. The concerns center on the insurer’s submission of risk-adjustment data, specifically diagnosis codes that CMS alleges were not supported by corresponding medical records.
According to correspondence from CMS’ Medicare Parts C and D Oversight and Enforcement Group, Elevance had acknowledged that some submitted diagnosis codes may have lacked sufficient documentation. The regulator also indicated that the company declined to make corrections through official reporting systems for codes identified as potentially unverifiable.
CMS noted that Elevance had, in multiple communications between 2018 and 2025, informed the agency it did not intend to revise certain data submissions. These interactions formed part of the basis for the regulator’s concerns and its initial move toward potential sanctions.
Elevance was originally given a deadline of March 31 to address the issues. The company has since confirmed that CMS has extended this deadline to May 30, providing additional time to review and potentially correct the data in question.
As part of the updated regulatory response, CMS also indicated that several Medicare Advantage plans previously flagged for possible sanctions will now be exempt from penalties, at least during the extended compliance period.
In a statement, Elevance said it maintains confidence in the compliance and integrity of its Medicare Advantage operations, citing existing oversight, monitoring, and governance processes. The company also stated that the matter does not affect coverage or benefits for policyholders.
The situation highlights ongoing regulatory scrutiny of risk-adjustment practices within Medicare Advantage, where accurate data reporting is critical to determining payments and ensuring program integrity.
Elevance Health’s operating entities currently hold financial strength ratings of A (Excellent) and A- (Excellent), reflecting strong claims-paying ability as assessed by industry rating agencies.
