July 16, 2026

This article reports new federal data on the size and growth of the 340B Drug Pricing Program and highlights ongoing policy debates among hospitals, drug manufacturers, and lawmakers regarding the program's oversight, transparency, and future reforms.

This article outlines CMS's proposed Medicare reforms and summarizes stakeholder reactions, highlighting potential impacts on physician reimbursement, quality reporting requirements, and the expansion of value-based care models.

Earlier this year, CMS lost a lawsuit brought by Clover Health, which argued that regulators had improperly included 20 measures in the 2026 Star Ratings calculations. Star Ratings were then recalculated, but 10 of the 20 contested measures were retained. In addition to Elevance, SCAN Health Plan and Alignment Healthcare have now filed lawsuits challenging the recalculated ratings.

The HHS Office of Inspector General reported generating $5.6 billion in recoveries from fraud, waste, and abuse enforcement between October and March and excluded more than 1,200 individuals and entities from participating in federal healthcare programs. The report identifies Medicaid and Medicare Advantage as key enforcement priorities, highlighting increased scrutiny of Medicaid fraud, autism therapy billing, and Medicare Advantage risk adjustment and coding practices.

The pilot program, called Restore, will give physicians more visibility into how patients are recovering after knee or hip replacement surgery. The program will be tested across three clinics in California with more than 100 participants. By using wearable biometric data and between-visit care coordination, Restore aims to improve recovery outcomes, including range of motion in knee and hip flexion, while also helping reduce opioid use after surgery.