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 ...

CMS blocks durable medical equipment enrollments nationwide with a six-month moratorium to curb suspected fraudulent billing in Medicare programs.

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 ...

Despite the late Justice Louis Brandeis's famous praise of the American political system for helping courageous states serve as "laboratories of democracy," the Centers for Medicare & Medicaid ...