In risk adjustment audits, common red flags include inconsistent documentation, such as when diagnoses are not uniformly recorded across different visits or by various providers. This inconsistency raises concerns about the accuracy and reliability of the coding. Additionally, a lack of supporting clinical evidence for documented diagnoses is a major red flag, as auditors expect clear, substantiated records that justify each diagnosis code. Overcoding or upcoding is another significant red flag, particularly when there is a pattern of coding more severe or complex conditions than what is supported by the clinical documentation. This can lead to inflated risk scores and higher payments, drawing scrutiny from auditors. Similarly, an unusually high frequency of certain high-risk diagnoses without appropriate justification can suggest errors in coding. Other red flags include missing annual documentation for chronic conditions, late or backdated entries, and discrepancies between what is documented in the electronic health record (EHR) and what is submitted in claims data. These issues indicate potential coding inaccuracies which can trigger deeper audits and possible recoupment of payments.