On February 25, 2026, the Centers for Medicare & Medicaid Services (“CMS”) announced several program integrity actions impacting Medicaid funding and Medicare supplier enrollment, along with a request ...

While the fraud scandal in Minnesota has set in motion renewed scrutiny of Medicaid and other low-income support programs, the potential for losses in another large entitlement, namely Medicare, ...

CMS is requiring all 50 states to audit Medicaid providers and submit detailed plans to the agency by May 23, with hospital leaders eager to understand both the scope and the limits of what’s being ...

Amber Nigam is CEO and cofounder of basys.ai, a Harvard-based company streamlining prior authorization for health plans with agentic AI. Fraud, waste and abuse (FWA) has historically been addressed at ...

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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 ...

Conclusion The 340B rebate pilot weights program integrity against financial stability for safety net providers. A formal evaluation will be necessary to assess whether and to what extent the program ...

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 ...

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 ...