ELV · 10-Q · 2026Q2 · Full report

Medicare Risk Adjustment / RADV

Elevance Health, Inc. · 2026-07-15 · Importance 72 · Surprise 74 · In source text

Elevance notes CMS plans to substantially increase the scale and pace of Risk Adjustment Data Validation (RADV) audits (announced May 2025) and warns that changes to risk-adjustment auditing could increase financial recoveries from plans. The company received a February 2026 CMS notice regarding Medicare Advantage risk adjustment data submission requirements for dates of service 2015 through April 2023 and was provided specific steps with a July 31, 2026 deadline to avoid sanctions. On July 13, 2026 CMS confirmed Elevance completed required steps, that sanctions would not be imposed, and closed enforcement for this matter. Separately, Elevance recorded a loss contingency accrual for its best estimate of identified potential exposure related to resubmission of historical Medicare Advantage risk adjustment data, which materially increased Corporate & Other operating loss (Corporate & Other operating loss for six months ended June 30, 2026 was $(1,204) vs $(211) in 2025). The company continues to monitor RADV, audit outcomes and potential recoveries that could affect results.

Key facts

• CMS released our 2026 Star Ratings in October 2025, which reflect that approximately 59% of our Medicare Advantage members are enrolled in plans rated at least 4.0 Stars or higher (used to determine bonus payments in 2027). source
• Our 2025 Star Ratings reflect that approximately 40% of our Medicare Advantage members were enrolled in plans rated at least 4.0 Stars or higher (used for payment year 2026). source

Impact estimates