CMS Proposes Major Reforms to Medicare Advantage and Part D for 2027
CMS unveils significant Medicare Advantage and Part D changes for 2027, including Star Ratings overhaul and increased quality bonus payments, impacting Medicare spending by $14B.
CMS Finalizes 2026 Payment Updates and Policy Changes for OPPS and ASCs
CMS announces 2026 updates for OPPS and ASC payment systems, including expanded site neutral payments, skin substitute product unbundling, IPO list phase-out, and new hospital price transparency requirements.
CMS Proposes Major 2027 Medicare Advantage and Part D Updates Following Inflation Reduction Act
CMS's 2027 proposed rule outlines key Medicare Advantage and Part D program updates, codifying Inflation Reduction Act changes, adjusting Star Ratings, and modernizing marketing and risk adjustment frameworks.
OIG Finds Medicare Overpaying for Continuous Glucose Monitors; Recommends Payment Cuts
OIG report identifies Medicare overpayments for continuous glucose monitors and urges CMS to reduce payment rates, highlighting potential savings.
OIG Audit Finds Medicare Overpayments for Optometry Services in Nursing Homes
A recent OIG audit identifies $4.7 million in Medicare overpayments to optometrists for nursing home services due to insufficient CMS review processes and billing controls. The report urges enhanced oversight and provider training to prevent future improper payments.
GAO Identifies Ongoing Fraud Risks in Federal Marketplace APTC Program
GAO's recent report uncovers persistent fraud vulnerabilities in the federal Marketplace advance premium tax credit program, revealing risks related to SSN misuse, unreconciled credits, and unauthorized enrollment changes.
GAO Report Finds Persistent Fraud Risks in ACA Premium Tax Credit Program
The GAO's new report reveals ongoing fraud risks in the ACA's Advance Premium Tax Credit program, highlighting vulnerabilities in enrollment verification and CMS fraud management.
CMS Launches ACCESS Model for Tech-Enabled Chronic Care in Medicare
CMS announces ACCESS, a new Medicare model starting July 2026 to enhance chronic care using digital tools and outcome-based payments, supporting two-thirds of Original Medicare enrollees.
GAO Report Highlights Persistent Fraud Risks in Obamacare Premium Subsidy Program
GAO report reveals significant fraud risks and mismanagement in Obamacare's Advance Premium Tax Credit program, highlighting challenges in eligibility verification and fraud risk controls.
CMS Proposes Medicare Advantage and Part D Updates to Simplify Star Ratings
CMS proposes 2027 Medicare Advantage and Part D updates to simplify Star Ratings and introduce a depression screening measure. Public comment open for 60 days.