Advancing technology, evolving healthcare legislation, and the transition from fee-for-service to value-based care models is catalyzing a rapid transformation in American healthcare. Ensuring these ...

Late yesterday, August 28, 2013, the Centers for Medicare and Medicaid Services of the Department of Health and Human Services posted its Program Integrity: Exchange, SHOP, and Eligibility Appeals ...

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 ...

As the fog of the COVID-19 war continues to dissipate, it has become increasingly clear that hundreds of billions of dollars were needlessly added to the national debt due to the government’s ...

Although the nearly three-week government shutdown did real damage to the nation’s economy, it did have its bright side. For three weeks those of us who scan the Federal Register for new regulatory ...

Medicaid, the federal and state program that provides health coverage to low-income and elderly adults, children, pregnant women and people with disabilities, is countercyclical by nature. During an ...

“Program integrity” is the sort of technical term that sounds good. Who wouldn’t want to run Social Security with integrity? But unfortunately, in the Alice-in-Wonderland world of Washington-speak, ...

On February 25, 2026, the Centers for Medicare & Medicaid Services (“CMS”) announced several program integrity actions impacting Medicaid funding and Medicare supplier enrollment, along with a request ...

Boy, do you have your work cut out for you! Gov. Walz appointed you last month to the brand-new position of director of program integrity to strengthen fraud prevention. An agricultural metaphor may ...