Revenue Cycle & Payment Integrity
Expert articles and analysis related to revenue cycle & payment integrity.
AI Summary — Last 24 Hours
CMS and enforcement partners are intensifying payment-integrity pressure across Medicaid and Medicare-adjacent billing, with Dr. Mehmet Oz’s reported Medicaid fraud “war room” coinciding with aggressive state crackdowns and multiple new OIG/DOJ actions involving false claims, child identity theft, home health, vision services, and a $64M adult daycare Medicaid fraud scheme. For VBC stakeholders, the immediate risk is tighter scrutiny of delegated networks, social-care/community-based providers, and high-utilization ancillary vendors—especially where ACOs, Medicaid MCOs, and value-based contractors rely on downstream documentation and encounter-data accuracy for shared savings, capitation, and quality performance. Meanwhile, hospital revenue-cycle leaders face continued transparency exposure as more facilities comply with CMS price transparency rules but more than half remain short of full compliance, raising payer-contracting and consumer-affordability stakes alongside renewed pressure to reform No Surprises Act IDR processes ([Medicaid fraud crackdown](https://connect.kff.org/e3t/Ctc/RB+113/c1ThL04/VVvk-z5DzPW6N5zYDr5CvV26W6wcfC_5TQGgHN2ZRHzv5nR3bW50kH_H6lZ3msW8wqtrZ3vvp7RW2HMskl4bv1LvN6ZkgYJPj83SN3SLqtZkLmxw
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Brooklyn Adult Daycare Owner Sentenced to Prison for Leadership Role in $64M Medicaid Fraud Scheme - Department of Justice (.gov)
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