Medicare Advantage
GAO: VA and Medicare Advantage Improper Payments Expose Risk Gaps
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.
Medicare Advantage
Prior authorization
CMS-0057-F Prior Authorization Rule: No Verification Behind the Numbers
CMS-0057-F requires payers to publicly post prior authorization metrics — but CMS's own rule text confirms no independent audit or certification process backs the disclosure. The insurance industry's voluntary pledge has the identical gap.
Healthcare enforcement
CMS Simplified Medicare Advantage Stars for 2027. The Incentive Story Matters More.
The final rule narrows the Star Ratings framework, preserves the historical reward factor, and adds a new future behavioral health measure — a mix that matters for Medicare Advantage leaders, quality teams, and finance executives.
Medicare Advantage
JEC Argues MA Overpayments May Be Flowing Through the Part B Premium Formula
A Joint Economic Committee issue brief argues Medicare Advantage overpayments may raise Part B premiums for all beneficiaries via the premium-setting formula—shifting the debate from program cost to premium fairness and increasing attention on risk-adjustment defensibility.
Financial Regulation
CMS Just Turned Medicare Advantage Rate-Setting Into a Two-Date Repricing Structure
CMS’s 2027 MA Advance Notice sets a near-flat headline update, but the staged Advance Notice-to-April announcement cycle creates two repricing moments and elevates encounter linkage and documentation defensibility as economic variables.
Financial Regulation
CMS’s 0.09% Headline Masks a Deeper Medicare Advantage Reset
CMS proposed a +0.09% net Medicare Advantage payment update for 2027, offsetting nearly 5% effective growth through normalization and diagnosis-source adjustments, materially tightening plan economics.