A federal judge has vacated several key components of a controversial 2025 program integrity rule for the Affordable Care Act ...

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 ...

Medicaid program integrity efforts have been ramping up quickly, and last week we saw clear evidence of this trend when the ...

* * * Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program Notice for Proposed Rulemaking (CMS-2434-P) The Centers for Medicare & ...

The Deficit Reduction Act of 2005 provided the resources to establish the Medicaid Integrity Program (MIP), the first national strategy in the 40-year history of the Medicaid program to promote the ...

CMS must increase its oversight of Medicaid managed care programs by requiring states to audit payments to and by managed care organizations, according to a Government Accountability Office report. In ...

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 ...

Leading Republicans are looking toward the Government Accountability Office (GAO) to ensure CMS' new premium stabilization demonstration program is legal and in the best interest of seniors. In a ...

New federal guidance aimed at placing tighter budget neutrality requirements on Medicaid Section 1115 waiver programs is ...

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 ...