ARCLIGHT

Publication library / policy research

Arclight Insights

Policy Research on Complex Systems

Featured Research

Featured InsightMay 2026

Due Process Denied

Medicare Appeals, Wound Care, and the Right to a Meaningful Hearing

Lance McNeill, MBA, MPAff

Medicare's appeals system offers multiple levels of review, but those levels can create the appearance of due process while withholding its substance. This paper uses a wound-care appeal case study to show how related claims from the same patient, same wound, same care plan, and same product can be fragmented across multiple appeal numbers, reviewers, and judges - while the denial theory shifts at every stage. The result is what the paper calls a "no-rebuttal ratchet": providers respond to one rationale, only to face a new one in the next decision, often while recoupment continues. Due Process Denied argues that Medicare can protect program integrity without forcing providers into a multi-front procedural endurance contest. It proposes practical reforms including episode-of-care docketing, Material Issues Notices, rationale ledgers, QIC claim maps, pre-denial reviewer conferences, contractor accuracy metrics, and recoupment stays when rationale drift or appeal-scope ambiguity prevents meaningful review.

MedicareDue ProcessWound CareProgram Integrity

Additional Insights

Featured InsightMay 2026

Design Before Deploy

Objective-Function Governance for AI-Assisted Medicare Review

Lance McNeill, MBA, MPAff

How WISeR, Private-Payer AI Denials, and Medicare Audit Appeals Reveal Why High-Stakes Public AI Systems Must Be Co-Created Before Procurement

AI GovernanceMedicareHealthcare Policy
Policy White PaperMay 2026 - Updated Edition

Upstream Denials, Downstream Costs

Hidden Systemic Costs and Measurement Failure in Medicare Unified Program Integrity Contractor (UPIC) Determinations

Lance McNeill, MBA, MPAff

UPICs are paid to find fraud, waste, and abuse. But who measures whether their determinations are right? This updated Arclight Insights white paper estimates the hidden systemic cost of reversed, plausibly reversible, and unappealed UPIC determinations at $49 million to $250 million annually, while documenting a deeper measurement failure: CMS does not publish contractor-level appeal outcomes. The paper argues that Medicare program integrity should measure accuracy, not just activity.

MedicareUPICProgram IntegrityAppeals
White PaperApril 2026

Pricing Spike to Spiral

How reimbursement dynamics and incentives create rapid pricing escalation in skin substitute markets.

MedicareHealthcare PolicyProgram Design
AnalysisApril 2026

Rationale Drift in Medicare Audit Appeals

How denial rationales shift across audit stages, undermining due process and consistent adjudication.

MedicareAppealsDue Process
EssayMay 2026

Common Sense 250 Years Since

A Legitimacy Audit for the AI Republic at America's 250th Birthday

Lance McNeill, MBA, MPAff

Two hundred and fifty years after Thomas Paine used Common Sense to challenge inherited authority, this essay asks what a legitimacy audit would reveal about American public institutions today. It argues that declining public trust, fiscal opacity, institutional capture, and administrative complexity are not just political frustrations; they are design failures that become more dangerous as artificial intelligence enters the machinery of government. The essay makes a case for AI as a civic accountability layer: not a tool merely for government to process, monitor, or enforce faster, but a tool citizens can use to see public power more clearly. Its central principle is simple: audit before automation, co-creation before deployment, and public purpose before institutional convenience.

Civic AccountabilityAI GovernancePublic TrustAmerica 250

Listen to Narration