New York is about to get the Oz treatment. Medicaid czar Dr. Mehmet Oz is turning up the heat on Gov. Kathy Hochul, launching an investigation into the state’s massive $124 billion Medicaid program — ...

As it continues to put a focus on addressing fraud, waste and abuse in healthcare, the CMS said it is also seeking feedback on additional fraud prevention strategies it could use in a future rule as ...

Agentic AI can connect historical behavior, evolving utilization signals and payment integrity requirements into a single control framework that adapts over time.

The Centers for Medicare & Medicaid Services (CMS) on Wednesday singled out personal care and home- and community-based services (HCBS) in announcing ...

The decision is part of a crackdown on fraud to prevent payment of questionable claims while further investigation is completed, HHS says.

In post-acute care, Medicare is not an abstract federal program. It is Mrs. Thompson’s therapy after a hip fracture. It is Mr. Alvarez’s swallow ...

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 ...

Despite the late Justice Louis Brandeis's famous praise of the American political system for helping courageous states serve as "laboratories of democracy," the Centers for Medicare & Medicaid ...

President Donald Trump’s administration has moved to shut down a long‑running Medicaid financing loophole that officials say allowed states to shift billions in costs onto federal taxpayers. The ...

The federal government must do a better job of folding aging services providers into healthcare solutions as it seeks to reduce administrative burdens, limit unnecessary hospitalizations and improve ...