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 ...

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 ...

The Centers for Medicare and Medicaid Services (CMS) issued a Request for Information (RFI) on February 27, 2026, that signals a potential expansion of federal health care fraud, waste, and abuse ...

The Centers for Medicare & Medicaid Services (CMS) is rolling out major 2026 reforms affecting provider enrollment, ...

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, ...

The 340B rebate pilot model set to begin in January 2026 starkly presents the key tradeoff between program integrity and support for safety net providers and poses an important question: can the 340B ...

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 ...

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 ...

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 ...