Risk Adjustment & Compliance
Expert articles and analysis related to risk adjustment & compliance.
AI Summary — Last 24 Hours
CMS is sharpening program-integrity expectations across public coverage: Dr. Mehmet Oz directed state Medicaid agencies to submit 30-day plans for a two-year provider revalidation strategy, signaling heightened scrutiny of enrollment validity, improper payments, and downstream managed-care/network compliance risks for Medicaid MCOs and VBC providers (Healthcare Finance). At the same time, Medicare Advantage oversight remains in flux, with recent MA policy changes adding some beneficiary protections while rolling back others—raising continued risk-adjustment, utilization management, and compliance tensions for MA plans, ACO-aligned providers, and payers managing total-cost-of-care contracts (KFF.
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