Medicare Advantage Signal Feed

CMS’s 2027 OPPS Proposed Rule Advances 340B Payment Reform, Site Neutrality, and Program Integrity

The post CMS’s 2027 OPPS Proposed Rule Advances 340B Payment Reform, Site Neutrality, and Program Integrity appeared first on Paragon Health Institute .

DOJ’s Claritev probe intensifies with new information demands

Claritev is accused of organizing a conspiracy among competing commercial health insurers to reduce reimbursements for out-of-network services.

H.R. 6622, Sunshine for Regulatory Decrees and Settlements Act

As ordered reported by the House Committee on the Judiciary on January 8, 2026

CVS Caremark reaches settlement with FTC over insulin suit

Terms of the deal announced Tuesday are very similar to those the FTC reached with Express Scripts earlier this year, including requiring the PBM to stop preferring higher cost versions of drugs on standard formularies.

What medtech’s selective dealmaking signals for 2026

Medtech deal activity has become more selective, with companies focusing investments on higher-growth and higher-margin categories.

How private equity is accelerating health systems’ growth

Health systems are using private equity-backed joint ventures to expand outpatient care, increase referrals, boost capital and limit costs.

Efforts to reform federal drug pricing program 340B continue with new report, proposed CMS rule

The federal drug pricing program 340B helps hospitals and clinics in Virginia and across the nation care for underserved patients by requiring pharmaceutical companies to offer prescription discounts to qualifying providers. But after some providers were caught taking advantage of the program and shortchanging patients, state and federal lawmakers have spent years deliberating potential reforms. […]

Priority Open Recommendations: U.S. Department of Agriculture

What GAO Found In May 2025, GAO identified 5 priority recommendations for the U.S. Department of Agriculture (USDA). Since then, USDA has implemented two of those recommendations. In June 2026, GAO identified an additional 3 priority recommendations, bringing the total to 6. GAO is highlighting the following three areas that warrant timely and focused attention: Improving IT modernization, Deterring SNAP retailer fraud, and Improving data sharing on foreign investment in U.S. agricultural lan...

Health Insurance Marketplaces: CMS Needs Stronger Controls to Prevent Unauthorized Actions by Agents and Brokers

What GAO Found Millions of consumers rely on the assistance of health insurance agents and brokers to purchase health insurance plans through federal and state Marketplaces established by the Patient Protection and Affordable Care Act. The federal Marketplace is maintained by the Centers for Medicare & Medicaid Services (CMS). To assist consumers in the federal Marketplace, agents and brokers must be licensed to sell health plans and be registered with the Marketplace, among other things. CMS...

Advancing healthcare engagement among older adults

Watch Jeff Fernandez, Medicare President at Aetna, discuss strategies to improve healthcare engagement, access and outcomes for older adults.

Unify for something greater: Celebrating the 2026 Univants of Healthcare Excellence winners

The UNIVANTS of Healthcare Excellence award program is a prestigious global award program created by Abbott in partnership with leading healthcare organizations with a common vision to inspire and celebrate healthcare excellence.

New Non-Partisan Watchdog Report Finds How Biden-Harris Administration Neglected Program Integrity Within Obamacare

**WASHINGTON, D.C.** - Ongoing investigative work conducted by the Government Accountability Office (GAO), in tandem with recent sentencings in federal cases targeting fraudulent enrollment, have uncovered concerning practices where fraudster agents and brokers enrolled patients in, or secretly swit...

Alignment Healthcare Inc. et al. v. Department of Health and Human Services et al.

Medicare Advantage Star Ratings litigation. The post Alignment Healthcare Inc. et al. v. Department of Health and Human Services et al. appeared first on Health Care Litigation Tracker .

CMS reports strong ACO REACH savings before model sunsets

Results published this week from the Centers for Medicare and Medicaid Services show ACO REACH closed out 2024 with strong savings and quality performance.

Medicare and Medicaid Programs; Application From The Joint Commission for Continued CMS Approval of Its Home Health Agency (HHA) Accreditation Program

This notice announces our decision to approve The Joint Commission for continued CMS recognition as a national accrediting organization for home health agencies that wish to participate in the Medicare or Medicaid programs.

CVS, Omnicare reach $440M settlement with Justice Department

CVS Health plans to sell its Omnicare pharmacy services subsidiary to GenieRx Holdings.

CMS Approach to Work Reporting Requirement Won’t Work for People with Substance Use Disorders or Mental Health Conditions

By Deborah Steinberg, Senior Health Policy Attorney, Legal Action Center A few weeks ago, CCF explained how the Centers for Medicare & Medicaid Services (CMS) issued a new interim final rule with comment period (IFR) that went far beyond its authority to implement the new work reporting requirements. H.R. 1 – the budget reconciliation law […]

An Executive Conversation with Jeff Fernandez, Medicare President, Aetna

SCAN Health Plan v. Department of Health and Human Services et al.

Medicare Advantage Star Ratings litigation. The post SCAN Health Plan v. Department of Health and Human Services et al. appeared first on Health Care Litigation Tracker .

Alignment faces whistleblower lawsuit over accounting claims

A former Alignment Healthcare executive alleges the Medicare Advantage insurer misclassified expenses to inflate earnings and executive pay.

Pearl Health raises $110M to expand Medicare-focused AI platform

Pearl Health’s artificial intelligence platform is designed to help providers manage their Medicare population.

S. 3468, National Programmable Cloud Laboratories Network Act of 2025

As ordered reported by the Senate Committee on Commerce, Science, and Transportation on February 12, 2026

Revalidation of ‘High-Risk’ Medicaid Providers: Early Lessons from Minnesota

On April 23, the CMS Administrator, Dr. Mehmet Oz, issued a letter to State Medicaid Directors “formally asking that your state develop and submit a comprehensive two-year provider revalidation (PR) strategy….” This SMD is not posted on Medicaid.gov with all the other SMDs, but you can view it on the Fox News website. The state […]

Digital Health Tools and Technologies: An Overview of CMS’ Recent Efforts to Expand Their Use in Medicare

As an increasing share of older adults have adopted digital health technologies over the past several years, and with most expressing interest in using them to manage their health care, the Centers for Medicare & Medicaid Services (CMS) has introduced several initiatives to expand the use of digital health technologies in Medicare. This brief summarizes these initiatives and draws on data from various surveys, including KFF Tracking Polls from September 2025 and March 2026, to highlight facts...

Privacy Act of 1974; Matching Program

In accordance with subsection (e)(12) of the Privacy Act of 1974, as amended, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) is providing notice of a re-established matching program between CMS and the Department of Veterans Affairs (VA), Veterans Health Administration (VHA), titled, "Verification of Eligibility for Minimum Essential Coverage Under the Patient Protection and Affordable Care Act". Under this Matching Program, CMS will share da...