The Centers for Medicare & Medicaid Services (CMS) this week released new data fueling a narrative of rampant broker fraud on the Affordable Care Act (ACA) exchanges. Plans received data finding 23% of enrollees did not have a claim in 2019. That number jumped sharply to 35% last year. Before the pandemic, the data were largely consistent across three categories: members on state-based exchanges, members on the federal exchange in Medicaid expansion states and on the federal exchange in non-expansion states. No matter the group, about 22% to 24% of enrollees did not have a claim.
CMS’ recent proposal to phase out the inpatient-only list is drawing mixed reactions from healthcare leaders. As part of the Outpatient Prospective Payment System proposed rule for 2026, the agency shared plans to eliminate the inpatient-only list, starting with 285 musculoskeletal procedures in 2026. Should it come to fruition, the change would mean hospitals could no longer bill Medicare for certain procedures that were previously reimbursable only when performed in inpatient settings. It also would mark a dramatic acceleration in the shift of surgical care to outpatient settings.
The hospital as we know it is on the brink of becoming unrecognizable. It’s no longer the central hub of healthcare and is rapidly becoming the most expensive and least convenient option. By 2030, up to 30% of hospital revenue could be lost to decentralized care models that are faster, more affordable and increasingly global. This shift is not just a trend; it’s a fundamental change in how healthcare is delivered and accessed, and it requires building resilience to adapt to new challenges and opportunities.
The drug price negotiation program has withstood another procedural effort in striking down one of the Inflation Reduction Act’s most significant provisions. In the U.S. Court of Appeals for the 6th Circuit, a panel of judges upheld (PDF) a lower court’s decision to dismiss the lawsuit. A judge dismissed the lawsuit last year, saying most of the plaintiffs lacked standing to bring the case, but the U.S. Chamber of Commerce was able to file a new suit. The U.S. Chamber could now appeal to the Supreme Court, reported The Hill.
The Office of Inspector General (OIG) has made 10 recommendations to the Veterans Health Administration (VHA) to improve processes by which the VA retrieves and documents the medical records from community providers and imports the records into the veterans’ electronic health records.
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