Agentic AI can connect historical behavior, evolving utilization signals and payment integrity requirements into a single control framework that adapts over time.

A third-party audit assessing Minnesota Medicaid programs at high risk for fraud found the state could safeguard $1 billion in the next four years by changing its policies on payment reviews. But the ...

The Tungsten+PLUS™ platform delivers comprehensive downstream services, including MFP claims reconciliation, dispute ...

What is new is the growing tendency to treat fraud enforcement as a spectacle rather than professional governance.

WOODSTOCK, GA / ACCESS Newswire / February 19, 2026 / Rural hospitals now have a once-in-a-generation opportunity to strengthen both care delivery and long-term financial stability through new federal ...

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 ...

While the report does not list specific dollar amounts or names, the director said the state’s fraud troubles are the result of decades of policy decisions, which he believes have created a culture of ...

CMS finalized a rule this week that ends what it called a healthcare‑related 'financing gimmick,' marking one of the most sweeping Medicaid program‑integrity actions in years. CMS said some states set ...

The Centers for Medicare & Medicaid Services (CMS) has released a proposal outlining 2027 payment and policy updates to Medicare Advantage (otherwise known as Medicare Part C), a private‑plan ...

The Centers for Medicare & Medicaid Services has announced the selection of 15 prescription drugs for the third cycle of the Medicare Drug Price Negotiation Program. These are high-cost drugs covered ...