Revenue Cycle & Payment Integrity

Payment integrity remains the main near-term VBC signal: Medicaid plans and providers face heightened compliance exposure as enforcement attention sharpens around fraud, documentation, and managed care oversight, making encounter-data quality, subcontractor controls, and risk-adjustment defensibility operational priorities for ACO-adjacent Medicaid strategies (Forvis Mazars). In Medicare Advantage and exchange markets, favorable risk-adjustment read-throughs lifted Centene and Oscar, reinforcing that coding accuracy and risk-score capture continue to drive payer economics even as CMS/HHS under the Trump administration scrutinize payment integrity and program integrity more aggressively ([MSN](https://news.google.com/rss/articles/CBMiwgFBVV95cUxORzhJM29xUEVrM2xZMktKeUtyU2wtcG9XMGFZeUZ1alRPUmV2S0ZITE1TM2NRX3BzZXNhallGN25Fa0dhNnpsTGRqM2VrY2Y1ZVF6M1pyVUU1Yk9lSjZNTjN4VVJIRVdhVFVYUHBYU05uSWRrbXZKNTVneDFidGtTRzFPb3Q2SUQ0NElCbkVLbXhpakJVWGFud