In fiscal 2023, the most recent year for which detailed financial information is available, Medicaid’s net cost was $894.2 ...

Here are five physician fraud cases Becker’s has reported on since June 17: 1. Columbus, Ohio-based Robert Florea, MD, was sentenced to 24 months in prison for a $1.5 million Medicaid fraud scheme. Dr ...

The Centers for Medicare & Medicaid Services is warning healthcare providers and suppliers about a new fraud scheme involving fake faxed requests for medical records. According to a June 26 alert ...

The Centers for Medicare & Medicaid Services today announced it has identified a fraud scheme targeting Medicare providers ...

The Centers for Medicare & Medicaid Services June 27 announced the rollout of a 6-year technology-enabled prior authorization ...

The Centers for Medicare and Medicaid Services is adjusting agent compensation for Medicare Advantage upward for 2026.

When you turn 65 and enroll in Medicare, your eligibility for Medicaid may change—even if your income stays the same. This is due to how Medicaid rules differ for people under and over the age ...

CVS Health's pharmacy benefit manager unit must pay the U.S. government $95 million after a federal judge found it ...

CMS will begin publishing skilled nursing facility ownership data to  its consumer-facing Care Compare website starting July 30.  CMS has published ownership information, including performance ...

The Financial Alignment Initiative for Medicare-Medicaid Enrollees targets dual enrollees and consists of a capitated model that provides prospective payment for coordinated care. 9 CMMI has also ...

Health insurers pledged to streamline and improve the prior authorization processes for plans covering nearly eight out of 10 Americans.

The Centers for Medicare & Medicaid Services (CMS) has unveiled a new initiative aimed at improving prior authorization ...