Compliance & Payment Integrity
Expert articles and analysis related to compliance & payment integrity.
AI Summary — Last 30 Days
Over the past 30 days, CMS has intensified its focus on compliance and payment integrity within value-based care, notably advancing efforts to scrutinize suspect billing and payment accuracy for ACOs and MA plans amid persistent oversight on risk adjustment practices—most visible in the extended implications of UnitedHealth’s RADV audit and the 2027 updates to Part D risk adjustment models. Structural pressures are mounting with new federal initiatives to address suspect billing, heightened Republican scrutiny of CMMI's model pipeline, and emerging multi-year obligations for payers reported in RADV-related enforcement.
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Indiana Generally Ensured That Selected Nursing Homes Complied With Federal Background Check Requirements - Office of Inspector General (.gov)
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Anchorage Doctor Sentenced To Prison In Multi-Million-Dollar Health Care, Tax Fraud Schemes - Office of Inspector General (.gov)
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Owners and CEO of Wholesale Pharmaceutical Company Sentenced for Distributing More Than $92M of Black-Market HIV Drugs - Office of Inspector General (.gov)
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