CMS
CMS announces aggressive nationwide crackdown on fraud
In a continuing effort to stop fraud before it starts, the Centers for Medicare & Medicaid Services (CMS) is taking decisive action to protect Medicare beneficiaries and taxpayer dollars through implementation of a six-month, nationwide data-driven moratorium on new Medicare…
The next step in preventing fraud
In recent weeks, the Centers for Medicare & Medicaid Services (CMS) announced that the “Fraud Takedown” resulted in the prosecution of over 300 defendants who committed over $14.6 billion worth of fraud against the Medicare program. The Medicare program is…
103,000 Medicare Beneficiaries are getting new Medicare numbers
The Centers for Medicare and Medicaid Services (CMS) have notified 103,000 Medicare beneficiaries that their personal information was used to create accounts on Medicare.gov. On May 2, 2025, the Medicare call center began receiving calls from beneficiaries who had received…
CMS Launches New Model to Target Wasteful, Inappropriate Services in Original Medicare
The Centers for Medicare & Medicaid Services (CMS) will partner with companies specializing in enhanced technologies to ensure people with original Medicare receive safe, effective, and necessary care. The Wasteful and Inappropriate Service Reduction (WISeR) will build upon other changes…
CMS expanding its efforts to audit MA plans
The Centers for Medicare and Medicaid Services (CMS) announced it is expanding its efforts to audit Medicare Advantage (MA) plans risk adjustment payments through the Risk Adjustment Data Validation (RADV) program. A risk adjustment factor (RAF) is calculated for each…
Operationalizing the scope of the Medicare drug negotiations
The Inflation Reduction Act of 2022 allowed Medicare to directly negotiate the prices of certain high-expenditure, single-source drugs without generic or biosimilar competition. The first set of negotiated prices will take effect in 2026. The Centers for Medicare and Medicaid…
CMS proposes $21B payment increase for Medicare Advantage in 2026
CMS has released a new advanced notice to increase payments to Medicare Advantage plans in 2026. CMS expects to spend $9.2 trillion over the next decade in an “effort to provide access to affordable, high-quality care in Medicare Advantage while…
ACA enrollment surges
As of January 4th, almost 24 million consumers have signed up for the 2025 Affordable Care Act (ACA) Marketplace coverage, according to the Centers for Medicare & Medicaid Services (CMS). Enrollment figures for 2024 were just over 21 million enrollees.…
Medicare’s hospital-at-home program
You may have heard of the “hospital-at-home program,” but do you know what it means? Hospital-at-home enables some patients who need acute-level care to receive care in their homes rather than in a hospital. The Centers for Medicare & Medicaid…
Guiding an Improved Dementia Experience
The Centers for Medicare & Medicaid Services (CMS) announced its new dementia care model. The model, Guiding an Improved Dementia Experience or (GUIDE), will be tested by the CMS Innovation Center as part of an initiative for Increasing Access to…