CMS Finalizes Rule Targeting ACA Enrollment Fraud, Aims to Lower Premiums
CMS finalizes new rule to reduce ACA improper enrollments, aiming to lower premiums and save taxpayers billions by 2026, while raising concerns over coverage losses.
Medicare Data Shows Rising CAS Use but No Shift Away from CEA Post-CMS Coverage Expansion
Analysis of Medicare data reveals increased carotid artery stenting use but stable carotid endarterectomy rates after CMS expanded CAS coverage in 2023, highlighting evolving vascular surgeon roles and compliance challenges.
CMS Expands Medicare Advantage Audits to Address $43B Overpayments
CMS is intensifying Medicare Advantage audits to recover $43 billion in overpayments, impacting provider contracts and regulatory compliance across the MA ecosystem.
2025 Medicare Advantage Star Ratings Drop Spurs Health IT Innovation Across Payers
The 2025 decline in Medicare Advantage Star Ratings intensifies regulatory scrutiny. Black Book Research reveals health IT strategies top plans use to boost quality, member experience, and compliance across all payers.
CMS Updates Kidney Care Choices Model to Improve Cost Efficiency Through 2027
CMS revises Kidney Care Choices Model with new financial methods and incentives to balance rising costs and quality improvements, extending program through 2027.
CMS Increases Oversight to Prevent Improper Medicaid Spending on Noncitizens
CMS ramps up oversight to stop misuse of Medicaid funds for noncitizen coverage, enforcing federal eligibility rules and recouping improper spending.
Federal Agencies Advance Healthcare Price Transparency with New RFIs and Guidance
U.S. federal agencies issue new guidance and requests for information to improve transparency in prescription drug and hospital prices, aiming to enhance data accuracy and compliance.
CMS Amplifies Medicare Advantage RADV Audits and Targets Medicaid Provider Taxes
CMS plans major expansion of Medicare Advantage RADV audits and proposes rules to limit Medicaid provider taxation practices, impacting insurer compliance and Medicaid financing.
CMS Expands Medicare Advantage Audits Impacting Major Health Insurers
CMS expands Medicare Advantage audits from 2018-2024, intensifying compliance demands and financial scrutiny for major health insurers like UnitedHealth, CVS, and Humana.
CMS Excludes Obesity Drugs from Medicare Coverage Amid Cost Concerns
CMS excludes obesity drugs from 2026 Medicare coverage, citing cost concerns; Eli Lilly criticizes the decision impacting obesity management treatments.