Payment Integrity
Expert articles and analysis related to payment integrity.
AI Summary — Last 7 Days
Payment integrity is tightening across Medicare Advantage, ACA Marketplace, and Medicaid, with CMS/HHS scrutiny converging on risk adjustment, eligibility, and federal matching funds—raising near-term compliance and revenue-cycle risk for plans, ACOs, and delegated provider groups. The $14M FCA settlement over alleged MA risk-adjustment fraud underscores continued exposure around diagnosis capture and coding governance, while HHS/CMS actions to identify potentially unauthorized ACA Marketplace enrollments could alter issuer morbidity, risk-adjustment transfers, and population health economics ([MA risk-adjustment FCA settlement](https://news.google.com/rss/articles/CBMirgFBVV95cUxNOENuVVJ5TmNsb1IzZDkwRW5SMHpBbmk2emFyYXN3TThkbzhXZFRRRENHYkpwbVFXRl9qVTBLY2pDVVJnYWo2c2dtTWZ4QVEtclJLM3RMNmZmQWR1bjBoOHk5Si1OR1NyN1dQR3JFWGp4NXpnWEk2cVJueWc3TjJBenZVMkVGRm9TWGtPdG13b2Y5LWZra2c4YXhwSVdkMEZNSUJrYU1xdXRaSVpJaFHSAbMBQVVfeXFMUEtkMVhoZkpzZno0bnNHb1hrTn
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