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 ...

Medicaid program integrity efforts have been ramping up quickly, and last week we saw clear evidence of this trend when the ...

As discussed in our prior Alert, on May 13, 2026, the Centers for Medicare & Medicaid Services (CMS) announced two nationwide, six-month moratoria ...

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 ...

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 ...

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 ...

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 ...

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 ...

Jeneen Iwugo, Acting Director for the Center for Program Integrity at CMS, discusses the potential of agentic automation to streamline decision-making processes, particularly in handling claims and ...

The Government Accountability Office has issued a report recommending CMS more clearly communicate its goals for the Medicare Integrity Program and improve the reliability of data used to calculate ...