Kim Brandt, CMS’s chief operating officer and deputy administrator, said AI tools are helping the agency stop money from going out the door to fraudsters.

Under a managed care arrangement, Medicaid MCOs determine the rates they pay providers for inpatient hospital services.

A congressional committee found that controversial practices like adding diagnoses in Medicare Advantage triggered higher bills for America’s seniors.

Health insurance company Aetna has agreed to pay over $117 million to Pennylvanians to resolve allegations that it violated ...

In its 2026 Physician Fee Schedule, CMS finalized a mandatory payment model that will begin Jan. 1, 2027, and hold certain outpatient specialists financially accountable for how they manage chronic ...

Medicare Advantage insurers say a proposal by the Trump administration to keep their payments nearly flat next year may lead ...

Medicare pays for services furnished in a physician’s office based on the Medicare Physician Fee Schedule (MPFS), while Medicare pays for similar services furnished in hospital outpatient departments ...

The One Big Beautiful Bill Act (OBBBA) included important reforms to limit states’ costly use of State Directed Payments ...

With cuts to Medicaid payments looming, one rural South Carolina hospital is asking legislators to ensure they have alternatives should finances turn dire. Allendale County Hospital is financially ...

UCare’s Medicaid payouts more than doubled in just three years, leading to record losses, the insurer’s demise and a trail of ...