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Healthcare developments · Oct 11, 2026

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Billing & paymentMedicare & MedicaidNew in this edition

Unpaid qualifying APM participants face October 13 billing-information cutoff

Certain unpaid qualifying APM participants must provide billing information by October 13 to avoid forfeiting their 2026 incentive. The October 5 Federal Register correction restores the download hyperlink; it does not extend the deadline. The payment concerns 2024 qualification and a 2025 payment base.

High priority · Oct 11, 2026 editionRead story →

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Payment & health plan rulesCompliance SweepNew in this edition

Transparency in Coverage final rule sets phased machine readable file changes

The October 6 Transparency in Coverage final rule phases in rate-file changes from March 6, 2027 and contextual-file and website requirements from September 6. Its explicit utilization-file posting date is July 1, 2028. Those duties, recurring posting cadences, and the December 7, 2026 legal effective date serve different purposes.

High priority · Oct 11, 2026 editionRead story →

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Consumer & business misconductEnforcement BriefingNew in this edition

AIDS Healthcare Foundation settlement highlights delayed diagnosis deletions

A Medicare Advantage settlement concerns diagnosis codes left unresolved after internal reviewers questioned their support. DOJ describes delayed investigation and deletion, while expressly retaining the allegations-only status of the resolved claims.

High priority · Oct 11, 2026 editionRead story →

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