Program integrity crackdown
Key Questions
What is the CMS FY2026 IPPS Proposed Rule?
It is the proposed rule updating inpatient hospital payment rates and policies under Medicare's Inpatient Prospective Payment System for fiscal year 2026. The rule revises inpatient service policies and introduces other refinements.
When was the FY2026 IPPS Proposed Rule released?
CMS released the FY2026 IPPS Proposed Rule recently, marking the start of the annual update cycle for hospital payments.
How does the IPPS Proposed Rule affect hospitals and Medicare policy?
The rule has direct implications for Medicare fiscal policy and hospital finances through updated payment rates and policy changes. It aims to refine inpatient hospital service policies and payment methodologies.
GAO report on improper payments in VA Community Care and Medicare Advantage identifies root causes and fraud risks. Treasury intercepts $99M in payments to deceased via death-master-file screening — concrete win. House subcommittee hearing on AI fraud in federal benefits; DOGE dead-people database controversy. Ongoing: $186B improper payments, DOJ $6.5B fraud takedown, CMS AI prevention pivot, Elevance $342M settlement, SNAP error rates, OMB fraud estimates $233B–$521B annually. USDA SNAP crackdown: 186k deceased recipients, 500k multi-state claims, 1,000 arrests. DOL strike team on NY unemployment fraud. GAO report on ACA marketplace fraud. CMS finalized 2.48% MA payment increase with upcoding crackdown. Ohio EVV mandate. CMMI transparency gaps. New: Bipartisan bill introduced to require physician review of AI-driven MA denials, transparency, and HHS reporting.