Cost & Payment Integrity
Expert articles and analysis related to cost & payment integrity.
AI Summary — Last 24 Hours
CMS/OIG payment-integrity pressure is intensifying around Medicare Advantage, with new MA-specific OIG guidance sharpening expectations for compliance, risk adjustment, marketing, and downstream vendor oversight—raising near-term exposure for plans and providers tied to MA value-based contracts. At the same time, provider-payer friction is escalating as 24 health systems plan to drop Medicare Advantage contracts in 2026, reflecting disputes over denials, administrative burden, and rates that could disrupt attribution, network adequacy, and population-health management for MA-aligned VBC models. Medicaid cost accountability is also moving to the foreground, with federal allegations involving New York’s $10B home care program and
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