Are Your Risk Scores Provable Under Audit? Why I Launched Bigelow Healthcare Consulting

CMS just announced it’s accelerating RADV audits to every eligible MA contract — annually. Coding staff ramped from 40 to 2,000. AI flagging tools deployed. Legal challenges ignored. Plans and providers of all sizes are now in the crosshairs.

Today I’m launching Bigelow Healthcare Consulting to help health plans and provider organizations answer one question:

Are your risk scores complete, accurate — and provable under audit?

Every risk adjustment program has ghosts in the machine. They hide in provider programs that make clinicians’ jobs harder. In encounter data that never reaches CMS. In analytics that are technically correct… but useless on the ground.

I’ve spent 13 years hunting them down and destroying them.

• Transformed a large, public plan’s analytics team into a powerhouse, delivering automated insights that freed up analysts to provide actionable support to operational leads.
• Reversed a five-year risk score decline by focusing on provider enablement and plugging data leaks.
• Guided a large provider organization through v28 implementation, balancing performance with provider-friendly programs.

In today’s v28 / 2027 landscape, accuracy isn’t optional. It’s survival.

I deliver end-to-end assessments across ACA, Medicare, and Medicaid:

• Provider enablement
• Policy translation to operations
• Data reconciliation & submissions
• Vendor management
• Analytics & reporting

If there’s a gap, I find it. If there’s a fix, I build it with your team.

If you’ve had that nagging feeling your RA program isn’t fully complete and accurate — especially with CMS knocking — let’s talk. A 30-minute call can reveal blind spots worth fixing now. Schedule a call.