CMS is signaling a new era of audit scrutiny. With the introduction of its 2026 pilot audit approach, CMS is recalibrating how it evaluates Compliance Program Effectiveness (CPE)—placing heightened emphasis on real-time operational integration, governance, and issue resolution rather than static documentation alone.

The Office of Inspector General (OIG) has released another targeted Medicare Advantage (MA) compliance audit, this time reviewing diagnosis codes submitted by UCare Minnesota (H2459).

CMS has officially appealed the federal court ruling that struck down its 2023 RADV Final Rule, reaffirming the agency’s commitment to defend extrapolation as a central tool in Medicare Advantage oversight. On Nov. 21, the Department of Justice filed a notice of appeal in Humana Inc. v. Kennedy to the Fifth Circuit Court of Appeals. The lower court had vacated the RADV rule on procedural grounds, finding CMS violated the Administrative Procedure Act by shifting its legal jus

Review CMS’ 2026 CAHPS updates and learn what health plans should prioritize now. Key deadlines, survey changes, strategy focus areas, and how Rebellis can help