Medicare & Medicaid · Sep 20, 2026

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Audits & program integrityMedicare & MedicaidContinuing

CMS reports $1.6 billion in Medicare laboratory program integrity actions across revocations, suspensions, recoupments and referrals

CMS’s August 28 laboratory announcement combines projected savings, suspended payments, recoupments and referral-related prevention. Its examples describe rapid billing intervention, but the headline total is not a single recovered sum or an adjudication that every associated claim was fraudulent.

High priority · Sep 20, 2026 editionRead story →

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Billing & paymentMedicare & MedicaidNew in this edition

CMS announces broad state participation in the GENEROUS Medicaid drug payment model and a September 30 signing date

CMS reports applications from every state, DC and Puerto Rico, but fewer signed GENEROUS agreements. The September 30 signing date remains ahead; applications alone do not establish each state’s participation terms.

Medium priority · Sep 20, 2026 editionRead story →

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Provider operationsMedicare & MedicaidNew in this edition

CMS corrects two October EDI spreadsheet errors, with October 1 applicability and October 5 implementation

The September 18 EDI transmittal replaces the August version to correct two 276/277 spreadsheet errors; systems implementation remains October 5.

Medium priority · Sep 20, 2026 editionRead story →

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Provider operationsMedicare & MedicaidNew in this edition

FY 2027 IPPS and LTCH instructions separate October 1 discharges from October 5 systems implementation

CMS’s September 11 instructions align FY 2027 inpatient rates, Grouper/MCE 44.0, Pricers and provider files with October 1 discharges and October 5 implementation.

Medium priority · Sep 20, 2026 editionRead story →