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 ...

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 ...

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 ...