Wakely Wire

February 12, 2026

New Insights

Events & More

Newsworthy Findings

Bonus Article

Just for Fun

New Insights

Whitepapers, briefs, press releases and more

Tending the Embers: Staying Audit-Ready for Medicare RADV

By Debbie Conboy

Tending the Embers: Staying Audit-Ready for Medicare RADV

With the January 27, 2026 announcement from The Centers for Medicare & Medicaid Services (CMS)1 regarding the Risk Adjustment Data Validation (RADV) program, it is clear that CMS intends to honor their commitment to strengthen oversight of Medicare Advantage (MA) payments, accelerate and expand the use of RADV audits, and utilize artificial intelligence to streamline ... Continue reading

Check Your ACA Risk Adjustment Data Validation (RADV) Engine Lights

By Debbie Conboy

Check Your ACA Risk Adjustment Data Validation (RADV) Engine Lights

Risk Adjustment Data Validation (RADV) audits are a critical component of the Affordable Care Act (ACA) Marketplace, ensuring accuracy of risk adjustment data submitted by health plans. These audits help verify validity and reliability of data used to calculate risk adjustment transfers. Operationalizing a RADV audit involves careful planning, resource allocation, and adherence to regulatory ... Continue reading

By Michael Cohen

Week in Washington – 2/12/26

CMS releases proposed 2027 ACA Rules CMS published its annual proposed Notice of Benefit and Payment Parameters that establishes rules that impact the 2027 individual and small group market. Wakely will be writing up a longer summary of the rule, here are a few key themes: Overall, the proposed rule is expected to reduce Marketplace ... Continue reading

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Events & More

CY2026 Trends in Medicare Advantage Part D Plan Benefits

WAKELY WEBINAR
February 25, 2026 | 12 PM ET

Join the experts from Wakely, an HMA Company, for a data-driven discussion of the key Part D benefit trends shaping Medicare Advantage Part D plans in CY2026. The Inflation Reduction Act’s Part D benefit redesign commenced January 1, 2025, with Maximum Fair Price drugs introduced January 1, 2026. As benefit design becomes more uniform across Part D plans, this webinar explores how sponsors adjusted the Part D benefits of their plans to meet the requirements of the legislation, while still remaining competitive. We will review the CY2025->CY2026 movements of Part D benefits and formulary placement, in addition to exploring benefit & formulary differences between MAPD & PDP plans for CY2026.

Learn more and register

Newsworthy Findings

CMS Proposes Sweeping ACA Exchange Rule

The CMS said the regulation should remove barriers to more affordable health plans, like catastrophic coverage, as enrollment on the exchanges falls.

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Editor's Note

The CMS proposed a handful of changes to Affordable Care Act (ACA) plans, including the expansion of availability to catastrophic coverage, the dropping of standardized plan design requirements for insurers on the federal exchange, the investigation of abusive health plan broker marketing practices, and the requirement of income verification checks during special enrollment periods. These changes aim to lower health care costs, expand consumer choice and protect taxpayers

House Republicans Subpoena 8 Health Insurers Over ACA Fraud

The subpoenas request additional documents and information from CVS, Centene, Elevance, and more.

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Editor's Note

House Republicans are considering legislation to combat what they view as rampant fraud in the ACA exchanges. They are worried about fraud stemming from the generous subsidies for plans in the exchanges put in place during the Covid-19 pandemic. It was cited that millions of ACA members generated no claims in 2024, suggesting that tens of millions of dollars in annual subsidies were pocketed by insurers. While health policy experts dispute this, there is still more research that suggests other instances of fraud. After failing to comply with a committee's request to share information about this potential fraud, eight major health insurers are being subpoenaed.

FDA Refuses to Review Moderna’s mRNA Flu Vaccine

Moderna claimed that the decision, issued by top vaccine regulator Vinay Prasad, was “inconsistent” with prior FDA communications and went against the regulator’s established guidance for flu shots.

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Editor's Note

The U.S. Food and Drug Administration has refused to review Moderna’s application for its mRNA-based seasonal influenza vaccine, issuing a rare refusal-to-file letter because the Phase 3 trial comparator didn’t meet the agency’s standards for the “best-available standard of care.” Moderna argues the FDA’s rationale contradicts prior guidance and has requested a meeting to clarify next steps, marking a significant regulatory setback for the company’s vaccine program.

Health Systems Beware: Digital Imaging Data is the Sleeping Giant

Memorial Sloan Kettering's enterprise architecture chief offers practical advice for getting a hold of this fast-growing challenge before it overwhelms storage and cost-management strategies.

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Editor's Note

Healthcare imaging data, including high-resolution CT, MRI, PET and digital pathology files, is growing exponentially and creating massive strain on storage infrastructure, network transport and cost management across health systems. Without strategic planning and investment in scalable data management, this “sleeping giant” of digital imaging threatens to overwhelm IT environments and impede both clinical care and research workflows.

CVS Holds 2026 Guidance Steady as Turnaround Plan Bears Fruit

The healthcare giant outperformed to close out 2025, and expects its finances to improve further this year. Still, proposed Medicare Advantage rates could be an issue moving forward.

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Editor's Note

CVS Health reported stronger-than-expected fourth-quarter revenue and earnings, beating Wall Street forecasts and reaffirming its 2026 guidance as its turnaround plan gains traction, though Aetna’s Medicare Advantage performance continues to be reshaped for better margins. Investors remain cautious given broader industry headwinds and proposed Medicare rate increases that could pressure future growth, even as Caremark and other segments show solid results.

Bonus Article

Apes Show Ability to Imagine in ‘Tea Party’ Experiments, and Scientists are Very Excited

Apes share the human ability to imagine and pretend, suggests new research that included a series of tea party experiments. They learned that apes can use their imagination and play pretend. One bonobo engaged with cups of imaginary juice and bowls of pretend grapes “consistently and robustly” across three experiments, challenging long-held assumptions about the abilities of animals.

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Just for Fun

Math Riddle

Why do Mathematicians love parks?

Prior Week

Q: I’m a whole number greater than 1. I’m not prime. If you add up all of my positive factors except me, you get exactly me. What number am I?

A: 6

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