Oversight & Compliance
Expert articles and analysis related to oversight & compliance.
AI Summary — Last 7 Days
Oversight pressure is intensifying around Medicare Advantage payment integrity: Centene sued HHS and CMS over 2027 Star Ratings methodology, arguing $448 million is at stake after courts rejected similar Star Ratings rules, while congressional-facing commentary continues to target MA risk adjustment as a source of coding-driven overpayment and compliance risk (Centene Star Ratings suit). At the same time, scrutiny of utilization management is widening beyond MA, with reports that CMS’ WISeR prior authorization model left patients waiting months for care and major employers pledging faster electronic prior authorization—raising the stakes for ACOs, MA plans, and VBC providers that rely on timely care navigation while facing tighter federal oversight of denials, quality scores, and payment accuracy (WISeR delays).
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