CMS require states audit Medicaid providers with plans due in 30 days to strengthen fraud detection and program integrity nationwide.

CMS is gathering information for and seeking industry feedback on a project that would consolidate the audit and investigation services for Medicare and Medicaid integrity functions, creating new ...

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, ...

A constant refrain from the Trump administration about rooting out fraud, waste and abuse isn’t just about budget cuts. For nursing homes, it may signal increasing audit risk and a rise in burdensome ...

The Government Accountability Office has issued a report recommending CMS more clearly communicate its goals for the Medicare Integrity Program and improve the reliability of data used to calculate ...

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 ...

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 ...

On September 30, 2025, the Centers for Medicare & Medicaid Services (CMS) published the final guidance for the third cycle of the Medicare Drug Price Negotiation Program, initial price applicability ...