The May 2025 issue of McDermott’s Healthcare Regulatory Check-Up presents key regulatory developments in the healthcare sector, with notable attention given to enhanced auditing efforts by the Centers for Medicare & Medicaid Services (CMS) targeting Medicare Advantage (MA) plans. This monthly update underscores the federal government’s expanding oversight of healthcare programs and its continued commitment to combating fraud and abuse.
A central development featured in this edition is CMS’s newly implemented strategy aimed at broadening and strengthening the auditing framework for MA plans. This initiative is part of a broader agenda to ensure integrity in Medicare funding and to prevent improper payments. The updated strategy is expected to increase the frequency and depth of Risk Adjustment Data Validation (RADV) audits and intensify scrutiny of MA plan practices.
The newsletter also details a series of recent enforcement actions that demonstrate ongoing vigilance by federal authorities in addressing healthcare fraud. Allegations under the Anti-Kickback Statute (AKS), the Stark Law, and the False Claims Act (FCA) continue to be at the forefront. Several cases involve fraudulent reimbursement claims submitted to Medicare for non-prescribed or excessive over-the-counter COVID-19 test kits. Other enforcement actions target schemes that sought reimbursements for medically unnecessary services through federal healthcare programs.
In addition to enforcement trends, the issue covers legislative and administrative developments. Among these is the introduction of the One Big Beautiful Bill Act, a proposal aimed at simplifying medical billing to reduce patient confusion and billing errors. The Make America Healthy Again Commission, established to examine systemic healthcare issues, is also discussed, particularly its agenda to propose reforms enhancing public health and healthcare system resilience.
Lastly, the CMS, in collaboration with other federal agencies, has issued a request for information (RFI) seeking public feedback on ideas to improve transparency in prescription drug pricing. This initiative reflects broader efforts to address drug affordability and market opacity.
Overall, the regulatory activity in May 2025 underscores the federal government’s multifaceted approach to improving healthcare system integrity, patient protections, and cost control. The increased enforcement activity and policy proposals indicate a trend toward greater regulatory rigor across the healthcare landscape.
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