CMS, the Office of Inspector General and other governmental agencies have ramped up their stance on healthcare fraud and abuse, estimating that roughly $4.1 billion in taxpayer money was recovered in ...

A constant refrain from the Trump administration about rooting out fraud, waste and abuse isn’t just about budget cuts. For nursing homes, it may signal increasing audit risk and a rise in burdensome ...

CMS has finalized policies from a proposed rule concerning the program integrity of the Patient Protection and Affordable Care Act health insurance exchanges. The final rule focuses on integrity ...

BOSTON, Dec. 15, 2025 /PRNewswire/ -- Basys.ai, an agentic AI-powered prior authorization and utilization management platform, has been selected by the Centers for Medicare & Medicaid Services (CMS) ...

Minnesota DHS announces a freeze on enrolments for new providers in 13 Medicaid service categories prone to fraud, aiming to ...

Since 1992, the 340B drug discount program has entitled certain federal grantee clinics and hospitals (called “covered entities”) to purchase outpatient drugs at substantial discounts. The discounted ...

As Congress continues to debate next steps on the Affordable Care Act's (ACA's) enhanced subsidies, insurers are urging legislators to consider an extension with additional program integrity measures ...

Medicaid is the joint federal-state health insurance program that provides medical coverage to almost five million low-income, elderly, disabled Floridians and children. Although the federal ...

The Government Accountability Office has issued a report recommending CMS more clearly communicate its goals for the Medicare Integrity Program and improve the reliability of data used to calculate ...