CMS introduces a new verification process for Medicaid and CHIP to ensure enrollee eligibility, safeguard taxpayer funds, and enhance program integrity with state-level review and enforcement.
New CMS data and state audits reveal rising fraud risks and improper payments in Medicaid and Obamacare exchanges, prompting regulatory reforms to enhance program integrity and protect taxpayer funds.
Federal court temporarily blocks key CMS rule on ACA health insurance exchange enrollment and eligibility pending further legal review, creating regulatory uncertainty.
Mayo Clinic hospitals received top quality ratings from CMS, with seven earning five stars, highlighting superior performance in mortality, safety, readmission, and patient experience measures.
A federal judge blocks key ACA regulatory changes that could affect 1.8 million Americans' health insurance, pausing new income verification and premium rules. Legal challenges continue.
A federal judge blocks major Trump-era ACA provisions that could lead to 1.8 million losing coverage, citing regulatory overreach and increased health costs.
CMS extends the Medicare off-cycle revalidation deadline for skilled nursing facilities to January 1, 2026, maintaining the existing requirements. Providers should prepare to comply to avoid Medicare participation disruptions.
Explore how CMS's Medicare Advantage Star Rating system's opaque methodologies create regulatory arbitrage and financial risks for insurers like Elevance Health, Humana, and UnitedHealthcare, shaping the healthcare insurance landscape.
Texas federal judge rules against Elevance Health in lawsuit over Medicare Advantage star ratings, impacting $375 million in bonus revenue. CMS methodologies upheld.
CMS proposes a 6.4% cut in 2026 Medicare payments to home health agencies, driven by PDGM budget neutrality adjustments and expanding Medicare Advantage enrollment. HHAs must assess financial impacts, advocate, and optimize operations.
