Risk Adjustment & Integrity
Expert articles and analysis related to risk adjustment & integrity.
AI Summary — Last 24 Hours
CMS is again recalculating Medicare Advantage Star Ratings after litigation over its methodology, with plans that benefit required to notify CMS by June 22; the move adds near-term revenue volatility to a bonus pool now worth roughly $16 billion and raises integrity concerns around measure calculation, appeals, and plan bidding assumptions (STAT). In parallel, OIG’s new Medicare Advantage industry-specific guidance sharpens scrutiny of risk adjustment, chart review, coding intensity, and vendor arrangements, while Arbital Health’s ATLAS launch signals growing demand from ACOs to model downside risk and benchmark exposure under CMS’s LEAD ACO program (PR Newswire.
Related Articles
Twenty-Six Charged in Indictment Alleging Federal Racketeering, Conspiracy, and Other Crimes - Department of Justice (.gov)
Twenty-Six Charged in Indictment Alleging Federal Racketeering, Conspiracy, and Other Crimes  Department of Justice (.gov)
Arkansas lab pays $30M to settle kickback allegations tied to gastroenterology practices - beckersasc.com
Arkansas lab pays $30M to settle kickback allegations tied to gastroenterology practices  beckersasc.com
Arbital Health Launches ATLAS to Model Financial Risk Under CMS LEAD ACO Program
Arbital Health Launches ATLAS to Model Financial Risk Under CMS LEAD ACO Program  TipRanks
OIG Publishes Medicare Advantage Industry-Specific Guidance
OIG Publishes Medicare Advantage Industry-Specific Guidance  JD Supra
PBM Audits Demand Pharmacy Awareness, Compliance, and Proactive Defense
Report: Provider-Driven Abuse of No Surprises Act 'Will Lead to Higher Spending and Higher Premiums'
Report: Provider-Driven Abuse of No Surprises Act 'Will Lead to Higher Spending and Higher Premiums'Â Â AHIP
UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK UNITED STATES OF AMERICA v. CARLOS NOEL, Defendant. SEALED COMPLAINT - Department of Justice (.gov)
UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK UNITED STATES OF AMERICA v. CARLOS NOEL, Defendant. SEALED COMPLAINTÂ Â Department of Justice (.gov)
What Is AI Getting Right — and Wrong — in Healthcare’s Revenue Cycle?
What Is AI Getting Right — and Wrong — in Healthcare’s Revenue Cycle?  MedCity News
United States v. Simons: Key Evidentiary Guidance in an Emerging Area of EKRA Enforcement
Quick Takes from Healthcare Financial Management Leaders at HFMA 2026 – Part 2
From AI and automation to revenue cycle optimization and financial sustainability, healthcare finance leaders are navigating significant change. At the HFMA Annual Conference, we asked industry expert...