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 ...

The Trump administration says its war on fraud applies to the entire country. But only blue states have had their Medicaid funding threatened or deferred, Democrats argued in a House subcommittee ...

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 ...

“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, ...

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 ...

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 ...

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 ...