Medicare Advantage
CVS is challenging 28 Medicare Advantage Star Ratings measures and seeking recalculated 2028 payments. Examine the legal arguments, Clover precedent, and implications for payer legal, compliance, quality, and finance leaders.
Healthcare compliance
ONC's HTI-5 final rule removes 14 certification criteria and revises seven, including changes to predictive AI transparency, testing, and interoperability. Explore the affected requirements, implementation timelines, and implications for developers and healthcare organizations.
Medicare Advantage
ACA Marketplace exits, Medicare Advantage plan and provider changes, and Medicaid financing restrictions are unfolding on different timelines. This brief separates the events, rules, and risks healthcare leaders need to track.
Healthcare AI
Major healthcare organizations are urging FDA to clarify responsibility for medical AI monitoring. Learn what AHA, AMA, ATA Action, and WEDI recommend and what the debate means for hospitals, developers, and patient safety.
Affordable Care Act
KFF reports an 18% decline in individual health insurance enrollment in 2026. Explore the gap between ACA Marketplace sign-ups and active coverage, rising premiums, administrative barriers, and implications for healthcare leaders.
Healthcare AI Regulation
Pennsylvania HB 1925 proposes new requirements for AI-assisted insurance decisions, including independent clinical review, patient-specific information, disclosure, and governance. Explore the bill's requirements, affected organizations, and how they compare with existing CMS rules.
AI Governance
CMS WISeR records and FOIA reporting highlight a broader AI governance issue: whether the full prior-authorization workflow is operationally ready before it affects consequential healthcare decisions.
Pharmacy Benefit Management
Florida’s PBM lawsuit against Prime Therapeutics and Express Scripts raises a larger oversight question: who controls pharmacy reimbursement, and can plan sponsors trace reported savings to net plan economics?
AI Governance
A PLOS review found only 3 of 1,357 FDA-authorized AI medical devices had patient-centered outcome evaluations. Here’s what FDA status proves—and what evidence still needs separate review.
Medicaid policy
CMS’s ABA toolkit gives states a nonbinding framework for treatment intensity, authorization, documentation, payment, and program integrity. It creates no national treatment-hour cap; implementation will depend on state or program action.
Healthcare compliance
A House committee advanced H.R. 9393, but the central implementation issue remains unresolved: CMS can enforce publication rules without independently proving that every reported price is contractually accurate.
Medicare Advantage
GAO found unfinished fraud-risk work at VA and CMS, including delayed Medicare Advantage RADV audits. The reported improper-payment figures are not fraud estimates.