The GAO's latest findings reveal ongoing fraud risks in the ACA's advance premium tax credit program, highlighting vulnerabilities in enrollment controls and CMS fraud management strategies.

Medicare star ratings reveal performance challenges for Quad Cities hospitals, with low sepsis care scores and high ER wait times prompting quality improvement initiatives.

KFF analysis of 2022 Medicare Advantage data shows 17% had diagnosis additions increasing CMS payments, with minimal diagnosis deletions impacting risk adjustments.

CMS proposes 2027 Medicare Advantage star ratings changes, removing Health Equity Index, adding depression screening measure, and refining enrollment policies to enhance care quality and plan comparisons.

Medicare Part B premiums increase 9.2% for 2026 as ACA subsidy expiration looms, impacting 22 million enrollees. CMS proposes cost-sharing reductions and new tools on Medicare.gov to manage rising healthcare costs.

Explore the challenges of ghost networks in Medicare Advantage and Medicaid managed care, highlighting network adequacy issues, limited CMS enforcement, and upcoming data transparency rules.

CMS updates Medicare Advantage policy to allow insurance coverage for federally and state-legal CBD products, amid evolving hemp regulatory definitions and market challenges.

CMS's WISeR Model introduces AI-powered prior authorization for Medicare outpatient procedures, impacting approval times and denials in six states starting 2026.

CMS releases Proposed 2027 Rules for Medicare Advantage and Part D, emphasizing Star Ratings simplification, marketing oversight updates, expanded risk adjustment data use, and Part D redesign implementation.

CMS introduces ACCESS model to enhance technology-supported care and outcome-based payments for Medicare patients with chronic conditions starting in 2026.