RISE summarizes recent regulatory-related headlines and reports.
8 insurers receive subpoenas over ACA subsidy fraud concerns
Republicans on the House Judiciary Committee have issued subpoenas to eight health insurance companies about potential fraud in Affordable Care Act (ACA) marketplace subsidies.
Subpoenas were issued to the chief executive officers of Blue Shield of California, Centene Corporation, CVS Health, Elevance Health, GuideWell, Health Care Service Corporation, Kaiser Permanente, and Oscar Health and demanded information on each company’s fraud protection measures. According to a news release issued by the committee, the eight executives failed to fully comply with a voluntary December request. The latest orders demand that the insurers provide the required documentation by February 23.
The orders were issued in the wake of a recent Government Accountability Office report that found billions of dollars in unreconciled ACA subsidies each year and examples of tens of thousands of Social Security Numbers subject to potential fraud.
The committee said that it is trying to determine whether the Administrative Procedure Act needs reforms in order to quickly implement health care fraud prevention measures. The Trump Administration last year finalized a rule to place new restrictions on improper enrollments, but a coalition of cities sued to stop implementation of the rule claiming that it will cause millions of Americans to lose coverage and crease an increase in premiums and out-of-pocket costs for others. In August, a federal judge paused certain provisions of the rule due to violations of the Administrative Procedure Act while the case winds its way through the courts.
Meanwhile, this week the Centers for Medicare & Medicaid Services (CMS) published a proposed rule for the ACA marketplace that would impose new subsidy eligibility rules beginning in 2027.
Scholars call for ‘Medicare Advantage Transparency Scorecard’
A team from the Johns Hopkins Bloomberg School of Public Health recommends that the Centers for Medicare & Medicaid Services (CMS) consider adopting a “Medicare Advantage Transparency Scorecard” as a complementary tool to Star ratings. The tool would be designed to increase visibility into Medicare Advantage organization practices and performance across key non-clinical domains, such as patient access to care, payment integrity, health equity, compliance and marketing, and corporate social responsibility, they write in a Health Affairs Forefront blog post.
The scorecard wouldn’t be tied to bonus payments or used as a formal regulatory enforcement mechanism. Instead, they propose that CMS, policymakers, researchers and the public to use it to assess how plans operate and how the operations impact beneficiaries, providers, and the Medicare program.
“Critically, the scorecard would focus on transparency rather than composite scoring or rankings,” they write. “Its purpose would be to illuminate variation, identify outliers, and support oversight—not to collapse complex plan behavior into a single performance grade.”
Open enrollment study: MA members who comparison shopped saved $1,600 per year
eHealth, an online health insurance marketplace, says a new analysis shows that people who comparison- shopped for 2026 Medicare Advantage plans realized significant savings on premiums and out-of-pocket costs.
The analysis found Medicare Advantage beneficiaries who worked with eHealth to compare their 2025 coverage to newer plans available for 2026 in their respective areas, saw an average potential annual savings of $1,676. That savings figure reflects lower out-of-pockets costs for medical care and prescription drugs, including reduced premiums and deductibles.
eHealth said the findings are important for enrollees to know during the Medicare Advantage Open Enrollment Period (January 1 through March 31), which allows consumers with Medicare Advantage plans to switch to a different Advantage plan or return to original Medicare, with or without Part D coverage.
However, its new eHealth survey found 48 percent of Medicare Advantage enrollees are unaware of this annual enrollment period, which means many of the 34 million Americans with this type of Medicare coverage may miss out on selecting a plan better suited for them. The survey findings are based on a nationwide, general population poll of over 1,000 Americans age 18 and older that was conducted on Dec. 19.
“With anxiety about health care costs at an all-time high, this analysis highlights the importance of researching available coverage options and making informed decisions based on personal preferences, health conditions, and financial situations,” said CEO Derrick Duke in the announcement. “While many Americans express confusion about how to effectively compare health plans, these data demonstrate that evaluating coverage options can help consumers save money while maintaining access to quality care.”
Other Medicare Advantage enrollment trends
ehealth also said that an analysis of Medicare Advantage plans selected by customers during Medicare’s recent Annual Enrollment Period (Oct. 15 through Dec. 7, 2025) also found:
- Eighty-eight percent of Medicare Advantage plans selected for 2026 had a $0 monthly premium, up from 87 percent the year before.
- The average monthly premium for 2026 plans was $4, down from $5 in 2025.
- A seven percent increase in the average out-of-pocket maximum, rising from $5,749 for 2025 plans to $6,153 for 2026 options.
The survey also found:
- Thirty-four percent of Americans do not know that recommended preventive health care screenings are covered at no cost by most health plans.
- Twenty-two percent of people do not know that annual physical and wellness checkups are covered at no cost by most health plans.
- Nineteen percent of Americans are unaware that flu and COVID shots are covered at no cost by most health plans.
- Sixty-nine percent of Medicare beneficiaries (and 54 percent of adults overall) seeking to lose weight in 2026 want to use GLP-1 drugs to meet their goals.
AMA, Vaccine Integrity Project collaborate on future respiratory virus vaccine review
The American Medical Association (AMA) will work with the Vaccine Integrity Project to create a structured, evidence-based review process to assess vaccine safety and effectiveness for the 2026–27 respiratory virus season. The review will focus on immunizations for influenza, COVID-19, and respiratory syncytial virus (RSV).
The collaboration follows a major upheaval within the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP), which determined vaccine policy in the United States for decades. That system has collapsed with recent vaccine decisions, the AMA said.
In an announcement, the AMA said the collaboration will establish a structured and durable process for evaluating the science underpinning respiratory virus immunization. The Vaccine Integrity Project, based at the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP), and the AMA will convene leading medical professional societies as well as public health and health care organizations to help define a comprehensive set of policy questions. The goal of this work is to ensure a deliberative, evidence-driven approach to produce the data necessary to understand the risks and benefits of vaccine policy decisions for all populations—the approach traditionally used by the federal government.
“Respiratory viruses hospitalize and kill tens of thousands of Americans every year, and vaccine decisions must be guided by facts, not politics or ideology,” said CIDRAP Director Michael Osterholm, Ph.D., MPH. “Our goal is to build on our efforts to restore peace of mind for clinicians and patients by ensuring that experts are continuously evaluating vaccine safety and effectiveness using transparent, evidence-based methods.”
Launched in April 2025, the Vaccine Integrity Project was created to ensure that vaccine use in the United States remains grounded in the best available evidence and focused on protecting public health. In addition to its 2025-26 evidence review for flu, COVID and RSV, the Project recently completed an evidence review of the birth dose of the hepatitis B vaccine and is in the process of reviewing data related to HPV vaccination.