Payment Integrity
Expert articles and analysis related to payment integrity.
AI Summary — Last 24 Hours
Payment integrity signals over the last 24 hours are centered less on new CMS rulemaking and more on operational friction: independent practices are facing destabilizing insurer payment delays, raising near-term risk for ACOs and VBC networks that rely on ambulatory access, timely cash flow, and predictable payer adjudication to sustain care-management infrastructure (Fierce Healthcare). Fraud enforcement also remains a live Medicare integrity pressure point, with a former NFL player sentenced to 16 years in a $197 million Medicare fraud case, reinforcing the Trump administration CMS/HHS imperative to tighten claims surveillance without creating blunt administrative drag for providers.
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[Correspondence] Fabricated citations at scale: from detection to prevention – Authors' reply
We thank Tiange Li and colleagues, and Ali Mohamed Mousa and Mervat Mahmoud-Katheer for their comments on our Correspondence.1 Our study was among the first systematic, large-scale audits of fabricate...