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

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 ...

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

WASHINGTON, D.C. — The Centers for Medicare & Medicaid Services (CMS) announced a new oversight initiative aimed at ensuring that enrollees in Medicaid and the Children’s Health Insurance Program ...

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 ...

In a letter sent today to Center for Medicare & Medicaid Services Administrator Mehmet Oz, a coalition of a dozen conservative and free-market organizations urged approval of Florida’s fiscal year ...

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 ...

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 ...