2027 HIX Rate Requests, 2027 Proposed OPPS/ASC Rule, M4A/Progressive HC Headlines - Mon. 7/6 HeartBeats

Research evidence excerpt

2027 HIX Rate Requests, 2027 Proposed OPPS/ASC Rule, M4A/Progressive HC Headlines - Mon. 7/6 HeartBeats

HEALTHCARE PROVIDERS & SERVICES

July 6, 2026

enrollment revocations, and strengthen efforts to remove non-compliant providers and

suppliers. CMS estimates these actions will save ~$82M annually while improving

payment integrity and home health quality reporting. (CMS Press Release, 7/1/26) Link

to Proposed Anti-fraud Measures, Link to Home Health PPS Proposed Rule

• Trump Administration Suspends Funding for New York Medicaid Fraud Unit:

The Trump administration has suspended federal funding for New York’s Medicaid

Fraud Control Unit (MFCU) through at least September 30, citing poor performance in

investigating and prosecuting Medicaid fraud and patient abuse. HHS Inspector General

stated that the unit secured only eight or nine criminal indictments in 2023 and 2025,

despite receiving ~$60M annually in federal funding and employing more than 270 staff.

The administration directed the unit to improve its performance before additional funding

is considered and said the suspension is part of broader nationwide efforts to strengthen

Medicaid fraud enforcement. (The Hill, Nathaniel Weixel, 7/1/26)

General News Scrape

• ELV - Elevance Health Sues CMS Over 2026 Medicare Advantage Star Ratings:

Elevance Health (ELV) has filed a lawsuit against CMS, alleging that the agency unfairly

recalculated competitor Clover Health’s (CLOV) 2026 Medicare Advantage Star Ratings

following a court ruling while denying ELV the same treatment. The insurer claims this

disparity could reduce its 2027 quality bonus payments by ~$115M. ELV argues that

removing the same 20 disputed quality measures used in Clover’s case would improve

ratings for five of its Medicare Advantage contracts.