Agentic AI can connect historical behavior, evolving utilization signals and payment integrity requirements into a single ...

As it continues to put a focus on addressing fraud, waste and abuse in healthcare, the CMS said it is also seeking feedback ...

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 ...

Workload data used by CMS to oversee Zone Program Integrity Contractors has been inaccurate and inconsistent, and this has led to several ZPIC reporting errors and inconsistencies within information ...

The Trump administration and 119th Congress are preparing to reduce federal expenditures by targeting Medicare and Medicaid fraud, waste, and abuse. Medicare enrollment revocations, Medicaid ...

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

The federal government must do a better job of folding aging services providers into healthcare solutions as it seeks to ...

CMS has announced it is consolidating its efforts with new program-integrity contractors that will look at billing trends and patterns across Medicare. These contractors will focus on companies and ...

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 ...

As discussed in last week’s Regs & Eggs blog post, the US Department of Health and Human Services (HHS) recently released additional budget documents to support the department’s fiscal year (FY) 2026 ...

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 ...