CMS’s Medicaid Deferral Power Clears Court Test
Program Integrity · Regulatory-analysis-led / Executive pressure-test · September 10, 2026 CMS’s Medicaid Deferral Power Just Cleared Its First Court […]
Risk Adjustment Data Validation Finds a $462M Code Gap
PCOOB Weekly · August 13, 2026 CMS Found a $462 Million Hole. It Chose Not to Close It. A new
Medicare Advantage Appeals: CMS Rule Meets AI Scrutiny
PCOOB Weekly · August 27, 2026 · Independent Payer Intelligence CMS Closed the Appeals Loophole. The Senate Wants the Algorithm.
Medicaid Fraud Control Unit Defunding: MCO Compliance
Medicaid Managed Care · Signal watch / Operational fault line · Aug 20, 2026 The Fraud Unit Got Defunded. The
CMS Won’t Say If PY2020 RADV Audits Extrapolate
Program Integrity · Regulatory-analysis-led / Operational fault line · August 13, 2026 The Records Are Due August 28. The Extrapolation
Medicare Advantage prior authorization denials
PCOOB Weekly · August 6, 2026 · Independent Payer Intelligence Medicare Advantage Prior Authorization Denials, When the Contractor Denies and
Medicaid Prior Authorization Data Is Now Visible to CMS
PCOOB Weekly July 30, 2026 | Vol. 2, Issue 27 When CMS Can See Every Denial The June 2026 MCPAR
The Directory Is Wrong. Twice.
PCOOB Weekly • June 23, 2026 • Regulatory Analysis The Directory Is Wrong. Twice. Medicaid managed care plans submit network
Elevance Health data certification non-compliance: Seven Years of Knowing. One Month to Fix It.
July 16, 2026 · Risk Adjustment / Program Integrity / Data Governance Elevance Health data certification non-compliance: Seven Years of
Reconciliation Law Rewires How Medicaid Plans Get Paid
Three simultaneous financing shocks, provider tax compression, state directed payment caps, and enrollment acuity shift, are now law for Medicaid managed care.
The Measure Is Gone. The Risk Isn’t.
Removing a measure from the Stars scorecard does not remove it from the compliance framework, the audit universe, or the enforcement landscape. Plans that read CMS’s voluntary 2027 recalculation,
D-SNP Compliance Now Runs on Two Regulatory Calendars
PCOOB Weekly — June 25, 2026 D-SNP / Duals / MA Compliance D-SNP Compliance Now Runs on Two Regulatory Calendars