States can align capitation withholds with value-based payment state-directed payment arrangements to incentivize managed care plans and providers to improve outcomes for dually eligible individuals.

The Deficit Reduction Act of 2005 provided the resources to establish the Medicaid Integrity Program (MIP), the first national strategy in the 40-year history of the Medicaid program to promote the ...

As Medicaid programs continue to grow in size, cost, and complexity, program integrity can no longer function as a standalone role—it must be built into the fabric of how programs operate daily.

Medicaid is the joint federal-state health insurance program that provides medical coverage to almost five million low-income, elderly, disabled Floridians and children. Although the federal ...

Many healthcare delivery organizations have adopted some form of value-based payment model in recent years, shifting the healthcare focus from quantity of services to quality of outcomes. In a ...

In order to advance Medicare-Medicaid integration, Congress and other policymakers need to recognize the Medicare-Medicaid Coordination Office at CMS as the central body designing and overseeing ...

On February 25, 2026, the Centers for Medicare & Medicaid Services (“CMS”) announced several program integrity actions impacting Medicaid funding and Medicare supplier enrollment, along with a request ...

IRVING, Texas, April 08, 2026 (GLOBE NEWSWIRE) -- Gainwell Technologies LLC today announced that New Mexico has deployed a comprehensive suite of the Health Management Systems, Inc. (HMS) program ...

The Trump administration and 119th Congress are preparing to reduce federal expenditures by targeting Medicare and Medicaid fraud, waste, and abuse. Medicare enrollment revocations, Medicaid ...

(MENAFN- GlobeNewsWire - Nasdaq) State modernizes quality assurance and expands tools to bolster program integrity and access to care IRVING, Texas, April 08, 2026 (GLOBE NEWSWIRE) -- Gainwell ...