Gainwell Technologies LLC today announced that New Mexico has deployed a comprehensive suite of the Health Management Systems, Inc. (HMS) program integrity and quality assurance capabilities to ...

While the fraud scandal in Minnesota has set in motion renewed scrutiny of Medicaid and other low-income support programs, the potential for losses in another large entitlement, namely Medicare, ...

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 ...

In this article, we outline actionable strategies for strengthening one of the most essential administrative data ...

The Centers for Medicare & Medicaid Services (CMS) has granted Elevance Health additional time to address alleged data ...

Amber Nigam is CEO and cofounder of basys.ai, a Harvard-based company streamlining prior authorization for health plans with agentic AI. Fraud, waste and abuse (FWA) has historically been addressed at ...

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 ...