Payment Integrity
Expert articles and analysis related to payment integrity.
AI Summary — Last 24 Hours
Payment integrity pressure is intensifying across VBC channels: DOJ announced a $6.5B national healthcare fraud takedown, including record Medicaid enforcement, while separate cases targeting Medicaid transportation kickbacks and Medicare billing schemes signal continued scrutiny of high-risk service lines. At the same time, MA prior authorization denials for post-acute care and ACA plan underwriting losses are pushing payers toward tighter utilization management and reimbursement controls—raising near-term friction for hospitals, SNFs, ACOs, and risk-bearing groups managing transitions of care.
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