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 Centers for Medicare & Medicaid Services (CMS) on Wednesday singled out personal care and home- and community-based services (HCBS) in announcing ...

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 ...

There are significant deficiencies in the Medicaid program's ability to detect and prevent fraud, waste and abuse, according to a report from the Government Accountability Office, which outlines key ...

We collaborate with the world's leading lawyers to deliver news tailored for you. Sign Up for any (or all) of our 25+ Newsletters. Some states have laws and ethical rules regarding solicitation and ...

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 ...

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 ...