Wakely Wire
September 10, 2026
New Insights
Whitepapers, briefs, press releases and more
CMS Section 1115 Budget Neutrality Review: What States Need to Prepare Now
What states and actuaries should know about CMS’s emerging budget neutrality certification process. CMS is moving toward a more detailed, activity-level review of Section 1115 budget neutrality. States may need to distinguish MAPS activities from Section 1115-only activities and provide stronger actuarial support for projected costs, savings, utilization changes, assumptions, and uncertainty. Who should read ... Continue reading
Week in Washington 09/10/26
CMS Continues DME Anti-Fraud Push CMS announced it would block 11 medical supply companies from receiving payments under Medicare Advantage or Part D. The firms were involved in $3.4 billion in suspected fraudulent billing practices in 2025 and 2026. The focus on DME billing practices is expected to continue. MA actuaries may need to reassess ... Continue reading
Newsworthy Findings
Mass General Brigham Health Plan Drops MA Coverage For Dana-Farber Patients
Mass General Brigham Health Plan has announced that it is eliminating the Dana-Farber Cancer Institute from its Medicare Advantage network Oct. 1. The insurer said it’s dropping coverage due to the challenging environment affecting Medicare Advantage plans nationwide.
Medicare Spent Hundreds of Millions of Dollars on Ineligible Drugs, Audit Finds
Medicare spent more than half a billion dollars over three years on drugs it shouldn’t have paid for.
Top Democrat Investigates No Surprises Arbiters
Rep. Frank Pallone sent oversight letters to six arbiters, requesting information on how they decide awards, how they’re paid and more. His office is also in communication with other arbiters.
HHS Announces $383.4M In Behavioral Health, Crisis Response Services Grants
The U.S. Department of Health and Human Services (HHS) awarded more than $383 million in grants Tuesday to strengthen the nation’s behavioral health treatment, prevention and crisis response services.
CMS Puts More Pressure on DME Suppliers as Part of Anti-Fraud Push
CMS added 11 durable medical equipment (DME) suppliers to its Preclusion List after identifying more than $3.4 billion in suspected fraudulent billing activity, including claims for deceased beneficiaries and equipment that was never requested or received.
Bonus Article
91-Year-Old "Grey Beard" Becomes Oldest Person to Hike the Appalachian Trail After 359 Days and 71 Falls
Just for Fun
Math Riddle:
Why do mathematicians never argue with circles?
Prior Week
Q: Using only addition, how can you make 1,000 from eight 8s?
A: 888 + 88 + 8 + 8 + 8 = 1,000
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