Wakely Wire

New Insights

Whitepapers, briefs, press releases and more

CY 2027 MSSP Proposed Rule Analysis: What the Medicare Shared Savings Program Changes Mean for ACOs

CMS has proposed one of the most significant sets of Medicare Shared Savings Program (MSSP) financial changes in recent years. While many of the proposed changes create new opportunities for Accountable Care Organizations (ACOs), others could significantly affect benchmark calculations, shared savings, financial forecasting, and strategic planning. Our latest white paper provides an actuarial and ... Continue reading

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Week in Washington 07/23/26

Regulations CMS Withholds Medicaid Funding –  CMS announced it would be withholding more than $1 billion in Medicaid funding for California and Minnesota over alleged fraud and non-compliance. The allegations center on in-home care programs. HHS announced it would also be seeking to expand its authority to remove participants due to suspected fraud. Prescription Drug ... Continue reading

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Newsworthy Findings

Novo Sues Lilly, Alleging ‘Misleading’ Advertising Of Obesity Drugs

Novo Nordisk is suing its biggest obesity drug rival, alleging on Tuesday that Eli Lilly is engaging in deceptive advertising by intentionally using outdated studies to compare the higher doses of its medicines to lower doses of Novo’s products.

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Editor's Note
The lawsuit comes as Lilly has gotten the upper hand in a high-stakes battle for market share. Lilly’s medicine, Zepbound, recorded $4 billion in sales in the first quarter of 2026 compared with the 18.2 billion krone, or $2.7 billion, generated by Novo’s Wegovy. The turf war escalated this year with both companies launching obesity pills that could extend the reach of weight-loss medicines.

Clinic and Physician Practice Bankruptcies Spike in 2026 So Far

Clinic and physician practice bankruptcies snowballed in the first half of the year, even as the filings in the healthcare sector overall stabilized compared with historic averages.

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Editor's Note
Bankruptcies among medical practices made up nearly 30% of all healthcare filings in the first half of 2026, putting the sector on pace to reach its highest level of bankruptcies since 2019.

CMS Moves to Codify Limits on Medicaid Provider Taxes

The rule is meant to prevent states from guaranteeing that providers will be refunded for their tax costs, and should save Washington $246 billion over the next decade, regulators said.

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Editor's Note
CMS proposed new limits on provider and managed care taxes that states use to finance Medicaid, implementing provisions of the GOP’s “Big Beautiful Bill” and potentially reducing federal Medicaid spending by $246 billion over 10 years. The changes would tighten oversight and phase down allowable tax thresholds, which providers and states warn could reduce Medicaid funding, strain safety-net providers, and contribute to coverage losses.

Clover Health Hit with Data Breach

The insurer, which disclosed the breach in a securities filing late last week, doesn’t yet know what type of data was exposed or how many people may have been impacted.

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Editor's Note
Clover Health disclosed a data breach after hackers used social engineering to access three employees’ accounts, potentially exposing members’ personal and protected health information. The insurer has contained the breach and is investigating, but has not yet determined what data was accessed or how many members may be affected.

CMS Appeals Court Decision Behind 2026 MA Star Ratings Recalculations

The Trump administration has appealed a Georgia federal court ruling that required CMS to recalculate 2026 Medicare Advantage Star Ratings, a decision that could significantly affect quality bonus payments and has prompted additional lawsuits from several health insurers.

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Editor's Note
This article highlights the ongoing legal and regulatory uncertainty surrounding Medicare Advantage Star Ratings and underscores the potential financial and policy implications of future court decisions for both CMS and MA insurers.

Bonus Article

Just for Fun

Math Joke:

Why are mathematicians great at parties?

Prior Week

Q: Why was the doctor great at algebra?

A: Because they always knew how to solve for X-rays,

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