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The Latest Breaking News from CMS

Appealed Prior Authorization Denials Are Often Overturned, but Reversal Rates Range from 16% to 93% by Insurer

Many insurance denials are reversed on appeal, but odds vary by plan. Learn how internal appeals and external reviews work and what to do first.

Medical Daily · Sep 15

Autism Therapy Clinics Lose Medicaid Payments Without Fraud Findings as Federal Crackdown Spreads to More States

Autism therapy providers in Nebraska, Colorado, and New York report lost Medicaid payments during a federal fraud crackdown, though none has been found guilty.

Medical Daily · Sep 14

Half of Medicare Advantage Quality Thresholds Got Harder for 2027, and Star Ratings Post in Early October

CMS draft cutpoints show that about half of Medicare Advantage quality thresholds tightened for 2027. What star ratings mean when you compare plans.

Medical Daily · Sep 14

From analysis to the latest developments in health,
read the most diverse news in one place.

Hospital Price Transparency Compliance Jumped to 49 Percent, but Only 18 Percent Post Real Dollar Prices Broadly

A watchdog scorecard found that 49% of hospitals fully comply with federal price rules, up from 21%. Only 18% post real dollar prices broadly.

Medical Daily · Sep 14

Marketplace, Medicare and Employer Plans All Cost More in 2027 as the Out of Pocket Cap Hits $12,000

Employer health costs may rise 8.2% in 2027, marketplace rates by about 15%, and the out-of-pocket cap may climb to $12,000. What is confirmed and what is not.

Medical Daily · Sep 14

Caps on State-Directed Medicaid Payments Could Cut 10 to 25 Percent of Medicaid Spending in 17 States

Medicaid payment caps in the 2025 budget law could cut 10% to 25% of total Medicaid spending in 17 states. Who is most exposed, and when?

Medical Daily · Sep 12

Banks Flagged $17.5 Billion in Activity Tied to Possible Health Care Fraud, with Home Health Named Most Often

Financial institutions flagged about $17.5 billion in activity possibly tied to health care fraud, most often naming home health firms. What families can check.

Medical Daily · Sep 11

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Your 2027 Social Security Raise Is Tracking at $70–$75 a Month. Medicare Is Already Lined Up to Take Part of It.

If you collect Social Security, there are two important dates to note. Friday, Sept. 11, the Bureau of Labor Statistics releases its official August inflation...

Saving Advice · Sep 11

Did Medicare Pay for a Test You Never Received? A New Fraud Crackdown Gives Seniors a Reason to Look

When was the last time you checked whether every laboratory test appearing on your Medicare claims was one you actually received? That question suddenly carries...

Saving Advice · Sep 10

CMS Is Targeting Unauthorized Health Insurance Enrollments—Here’s What Consumers Should Check

Imagine going to use your health insurance and discovering that the plan you thought you had isn’t the plan showing in the system or learning...

Saving Advice · Sep 10

157 Lab Providers Lost Medicare Billing Privileges—Here’s Why Checking Your Medicare Statement Matters

That unfamiliar laboratory charge on your Medicare statement may look like something only a billing department could understand, but it deserves more than a quick...

Saving Advice · Sep 10

When a Hospital System Buys Your Doctor's Practice, the Same Procedure Can Suddenly Cost Twice as Much

Hospital purchases of doctors' practices can steer patients to pricier settings and add facility fees. Here is how it works and what to ask first.

Medical Daily · Sep 10

Federal Regulators Bar Eleven Medical Equipment Suppliers That Billed Medicare for Beneficiaries Who Had Already Died

CMS barred 11 medical equipment suppliers tied to $3.4 billion in suspected fraudulent billing, saying all of them billed for deceased beneficiaries.

Medical Daily · Sep 10

6 Charges on Your Medicare Statement You Should Never Ignore

That Medicare statement arriving in the mail may look like another piece of paperwork you can glance at and file away, but doing that could...

Saving Advice · Sep 9

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Medical Daily · Sep 9

Retirees Track a 3.6 Percent Social Security Estimate as Medicare Premiums Threaten to Absorb Part of It

The 2027 Social Security COLA is projected at 3.6 percent. Rising Medicare Part B premiums will take a share before checks arrive.

Medical Daily · Sep 9

A New Elizabeth Holmes Documentary Arrives While the Lab Oversight Gap Theranos Exposed Remains Legally Unclosed

A new Holmes documentary premiered at Telluride. The patient-harm side of Theranos and the lab-oversight question remain unresolved.

Saving Advice · Sep 7

7 Medicare Fraud Red Flags Seniors Should Watch for After CMS Blocked $1.6 Billion in Payments

Medicare fraud can begin with something that doesn’t feel particularly dangerous: a phone call about a “free” genetic test, an unexpected package containing medical equipment,...

Everybody Loves Your Money · Sep 6

7 Signs Someone May Have Changed Your ACA Marketplace Coverage Without Permission

An ACA Marketplace health plan should not mysteriously morph into something different while its owner is busy living life. Yet unauthorized enrollment and plan changes have become a serious consumer protection issue, particularly when someone gains access to Marketplace information or acts without the consumer’s permission. CMS has taken steps…

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The Texas Tribune · Sep 4

AG Ken Paxton hasn’t challenged the Trump administration over Texas’ $10-billion Medicaid cut even though he sued Biden

The attorney general won a lawsuit against the feds for withholding a Medicaid funding stream three years ago. Texas faces the same cut, but Paxton has stayed quiet.

Everybody Loves Your Money · Sep 3

Could Someone Be Collecting a Commission From Your Health Insurance Without Your Knowledge?

A health insurance agent or broker can earn a commission from an insurance company when they help someone enroll in a plan, and that payment may never appear as a separate charge on the consumer’s bill. That does not automatically mean something shady happened, but it does create an important…

Kiplinger · Sep 3

8 Changes Coming to Medicare in 2027

Prepare for rising Part D costs, shrinking drug plan options, and newly negotiated prescription prices before Open Enrollment begins.

The Texas Tribune · Sep 2

In a rare move, Gov. Greg Abbott defends Medicaid funding for Texas

Abbott’s spokesman reiterated that Texas is not doing anything wrong that would disqualify hospitals from receiving nearly $10 billion in Medicaid funding annually.

International Business Times UK · Sep 2

Hospitals Claim New Trump Administration Medicaid Rules Could Cost Hundreds of Billions of Dollars

US hospitals warn that new Medicaid regulations could lead to service reductions, staff layoffs, and closures. Proposed rules aim to save billions but face opposition from hospital associations

The Texas Tribune · Aug 31

Texas hospitals say they’re losing $27 million a day in Medicaid funding

Starting Sept. 1, the Trump administration is withholding about $9.8 billion in extra funding that helps hospitals cover the difference between Medicaid payments and the actual cost of services.

inkl · Aug 31

5 Best Website Translation Tools in 2026 for CMS and MarTech Integration

Discover the best website translator tools for keeping multilingual websites synced, SEO-ready, and easy to manage across CMS and marketing platforms.

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