The WISeR model targets 17 items and services that are prone to waste, fraud, abuse and potential for patient harm.

Medicare has selected the technology vendors who'll run its prior authorization pilot in New Jersey, Ohio, Oklahoma, Texas, ...

The Centers for Medicare & Medicaid Services (CMS), the Office of the National Coordinator for Health Information Technology (ONC), and thr Department of Health and Human Services (HHS) published 89 ...

Beginning July 1, the Centers for Medicare and Medicaid Services will use a predictive modeling technology to combat Medicare fraud on a national basis, according to an agency announcement. The ...

In a Los Angeles Times op-ed, a CMS administrator said the Obama administration has used Medicare’s electronic payment system to its advantage in its fight against fraud. Peter Budetti, deputy ...

Government shutdown fix features retroactive Medicare telehealth pay to reimburse providers for claims since Oct. 1 and reprocess reduced payments.

On April 10, 2024, CMS published the fiscal year (FY) 2025 Medicare Hospital Inpatient Prospective Payment Systems (IPPS) Proposed Rule, which contains several key proposals that could provide ...

The CMS will crack down on overpayments to Medicare Advantage plans, moving to significantly expand its capacity to audit whether insurers are inflating their enrollees’ illnesses, the agency said ...

We collaborate with the world's leading lawyers to deliver news tailored for you. Sign Up for any (or all) of our 25+ Newsletters. Some states have laws and ethical rules regarding solicitation and ...