CMS finalizes 2025 Marketplace Integrity and Affordability Final Rule to tighten ACA Exchange enrollments, aiming to lower premiums but reducing coverage for some. Key provisions include subsidy restrictions and exclusions for DACA recipients.
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.
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 is intensifying Medicare Advantage audits to recover $43 billion in overpayments, impacting provider contracts and regulatory compliance across the MA ecosystem.
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 revises Kidney Care Choices Model with new financial methods and incentives to balance rising costs and quality improvements, extending program through 2027.
CMS ramps up oversight to stop misuse of Medicaid funds for noncitizen coverage, enforcing federal eligibility rules and recouping improper spending.
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 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 from 2018-2024, intensifying compliance demands and financial scrutiny for major health insurers like UnitedHealth, CVS, and Humana.
