Medicare Advantage Provider Directory Attestation Risk
PCOOB Weekly · Independent analysis for U.S. health plan leaders CMS Owns the Medicare Advantage Provider Directory Now. Your CEO
Medicare Advantage Star Ratings Lawsuit 2026 Update
Medicare Advantage · Regulatory-analysis-led / Executive pressure-test · October 15, 2026 CMS Likely Broke the Law on 2026 Star Ratings.
Medicaid Managed Care Capitation Rate Changes 2026
Medicaid Managed Care · Regulatory-analysis-led / Operational fault line · October 8, 2026 The Capitation Rate Was Certified. Then CMS
AI Prior Authorization Governance: The Senate Vote Explained
AI Governance · Regulatory-analysis-led / AI governance lens · October 1, 2026 CMS’s AI Prior Authorization Governance Pilot Clears the
Medicaid Parity Audits for Mental Health Parity Violations Persist, OIG Audits Show
Delegation Oversight · OIG report-led / Delegation oversight / Regulatory analysis · September 21, 2026 Medicaid Parity Audits for Mental
Medicare Advantage Delegation Oversight: CMS’s 2025 Report
CMS Regulatory Analysis · Regulatory-analysis-led / Operational fault line · September 17, 2026 CMS Made Its Audits Faster. The Findings
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