Compliance & Oversight

Over the past week, significant compliance issues have emerged, particularly with CMS's decision to halt enrollment in Elevance’s Medicare Advantage plans due to "substantial and persistent noncompliance" in reporting customer information, further underscoring the need for strict adherence to regulations in the Medicare landscape. Additionally, the Office of Inspector General (OIG) identified $285.2 million in improper payments related to autism therapy in Colorado, reflecting ongoing scrutiny about payment integrity and quality of care in Medicaid programs. These developments signal an increasing focus on oversight and compliance as key dynamics shaping the strategies of health systems and ACOs in a regulatory environment marked by heightened vigilance and accountability, potentially impacting funding and care delivery models. For more details, see the coverage on CMS halting Elevance enrollment and HHS's audit on autism therapy payments.