On April 2, 2018, the Centers for Medicare and Medicaid Services (CMS) issued instructions to Medicare Advantage plans encouraging more flexible service coverage policies in such plans for 2019. Such capitated plans cover the same services as traditional, fee-for-service Medicare, plus supplemental benefits adopted by the plan with CMS approval. Under the new CMS instructions, any Medicare Advantage plan would have additional flexibility to cover supplemental benefits to compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.

On February 20, 2018, the Government Accountability Office (GAO) released a report recommending changes in federal policies and procedures governing state-operated Medicaid demonstration waiver projects.  These projects represent the leading edge in state Medicaid innovation as well as over $109 billion in federal Medicaid spending annually. GAO found in its review of these projects that the Centers for Medicare and Medicaid Services (CMS) has not always demanded thorough, scientifically valid, and timely data evaluations as to whether the projects achieved state-specified, CMS-approved goals to improve care and to contain costs.  

On December 5, 2017, the Government Accountability Office (GAO) issued a a report on Centers for Medicare and Medicaid Services (CMS) fraud prevention efforts, recommending that CMS more closely align its approach with the Fraud Risk Framework put forth by the GAO in 2015. Medicaid and Medicare fraud and abuse prevention has been increasingly in the spotlight...