Maverick's Update

“I’m not supposed to lose. Let me see the script.” This is not what the coach of the England national football team said when Argentina beat them in the semifinal of the 2026 FIFA World Cup. Instead, this is a line delivered by “Robin Hood” in Mel Brooks’ 1993 spoof, Robin Hood: Men in Tights. The film makes fun of the English medieval tale about a clever thief who targets corrupt church officials and wealthy landowners, ultimately to redistribute that wealth to the poor. This is a great theme for our health policy topic in the One Thoughtful Paragraph. 

News this week that is unlikely to become American folklore: 

• CMS and the CDC issued a new request for information (RFI) seeking input on updating the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations—which have remained largely unchanged since 1992—to reflect advances in laboratory testing. Comments, including feedback on the use of AI in laboratory processes and cybersecurity, are due September 14, 2026 

• The Congressional Budget Office (CBO) is investigating how and what CMS fraud enforcement initiatives for federal health programs would generate the savings needed to offset spending from a new $95 billion budget reconciliation proposal by House Republicans. 

• The American Medical Association (AMA) announced an interoperability initiative to support electronic prior authorization before the January 1, 2027 CMS compliance deadline. AMA will align SNOMED CT clinical terminology with its Current Procedural Terminology (CPT) administrative coding system and work with health plans, EHR vendors, health IT developers, and other stakeholders to refine those crosswalks. 

One Thoughtful Paragraph

“We’re men / We’re men in tights / Always on guard / Defending the people’s rights.” While reading about Medicare fraud and abuse this week, this funny scene from Robin Hood: Men in Tights had me imagining some clever throng of do-gooders waiting in the woods to pounce on the corrupt jerks defrauding our seniors. The big news from this week’s proposed Physician Fee Schedule: CMS is cracking down on Medicare fraud, this time targeting people who abused pandemic-era flexibilities to bill for telehealth and remote patient monitoring (RPM) services. During the pandemic, fraudsters set up telemedicine companies, cold-called people, and generated orders for remote monitoring devices that were either unnecessary or were never delivered. Under the Biden Administration, the Department of Justice and the HHS Office of Inspector General began going after these billion-dollar fraud schemes in 2022. In 2024, HHS OIG found that 43% of Medicare enrollees did not receive the RPM they were supposed to, and in 2025, the OIG said that CMS needs to do more to address the fraud and uptick in spending. So, the proposed Physician Fee Schedule suggests banning third-party RPM companies altogether. Totally get it – but it’s undeniable that it is helpful to let people, say, use a blood pressure cuff at home to monitor their hypertension so their doctor can see the data without having to go anywhere. So how do we provide ample access to these services while preventing fraud? Maybe we make the fraudsters use their ill-gotten gains to pay for everyone else’s remote monitoring – like in Men in Tights: “We’re men / We’re men in tights / We rob from the rich and give to the poor / That’s right! 

Don’t forget to register for Maverick Health Policy and Longyear Health’s ACCESS Collaborative webinar on July 22nd at 12:00 PM EST, here.