CMS has just announced a major expansion of its audit program for Medicare Advantage (MA) plans—shifting from sampling a few contracts to...

In April 2025, the Centers for Medicare & Medicaid Services (CMS) issued a significant round of enforcement actions impacting a wide...

CMS has issued an HPMS memo  titled: “Deadlines for Submitting Risk Adjustment Data for Use in Risk Score Calculation Runs for Payment...

The Centers for Medicare & Medicaid Services (CMS) have introduced significant updates to the Hierarchical Condition Category (HCC) risk...

As of January 2025, the Centers for Medicare & Medicaid Services (CMS) imposed civil monetary penalties on several Medicare Advantage and...

Recent discussions around potential restructuring within the Department of Health and Human Services (HHS), including significant...

The Centers for Medicare & Medicaid Services (CMS) is sharpening its focus on Medicare Advantage (MA) plans, with special attention on...

Successful Medicare Advantage (MA) implementation depends on more than just hitting deadlines—it requires alignment across all health...

The Medicare Advantage market is ever-evolving, with Chronic Condition Special Needs Plans (C-SNPs) emerging as a notable growth area....

Coming out of the HCCA Compliance Conference this week, one thing is clear—compliance and regulatory oversight are evolving rapidly....

The Centers for Medicare & Medicaid Services (CMS) released its annual Program Audit Update memo, outlining critical changes and updates...

The Centers for Medicare & Medicaid Services (CMS) secret shopper program is an essential compliance check for Medicare Advantage and...

On November 14, 2024, the Centers for Medicare & Medicaid Services (CMS) initiated Payment Year (PY) 2018 Risk Adjustment Data Validation...

President Trump’s nomination of Dr. Mehmet Oz to lead the Centers for Medicare and Medicaid Services (CMS) could signal significant...

As the Arizona heat finally dips below 100 degrees, it’s starting to feel like Fall—my favorite season. Halloween is just around the...

SCAN succeeded in United States District Court after a federal judge agreed that the CMS improperly calculated its 2024 Star Ratings.