CMS require states audit Medicaid providers with plans due in 30 days to strengthen fraud detection and program integrity nationwide.

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 ...

Last week, federal agents suspended 447 hospices and 23 home health agencies in the greater Los Angeles area over allegations of Medicare fraud totaling ...

As previously reported by Sheppard, the Centers for Medicare & Medicaid Services (“CMS”) has announced several program integrity actions to combat health care fraud. Among these actions was the ...

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, ...

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 ...

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 ...

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 ...

President Donald Trump’s administration has moved to shut down a long‑running Medicaid financing loophole that officials say allowed states to shift billions in costs onto federal taxpayers. The ...