by Blog Master | Oct 2, 2026 | MarketingBlog, Uncategorized
Great conversations. Important work ahead. Thank you to Medicaid Health Plans of America (MHPA) and the Medicaid managed care community for a great few days in San Antonio! One thing remains clear: stronger program integrity requires more than identifying risk. It...
by Blog Master | Sep 30, 2026 | MarketingBlog, Uncategorized
Almost everyone in healthcare is talking about AI. That’s why simply saying “we use AI” is quickly becoming less meaningful. The more important questions are: What does your AI detect? What information can your analytics connect? Can you identify emerging...
by Blog Master | Sep 28, 2026 | MarketingBlog, Uncategorized
Medicare Advantage risk adjustment continues to be an area worth watching. In a newly released audit, HHS-OIG found that many of the selected high-risk diagnosis codes it reviewed were not supported by the underlying medical records, resulting in a significant...
by Blog Master | Sep 27, 2026 | MarketingBlog, Uncategorized
A recent DOJ case involving D.C. Medicaid offers a useful reminder about behavioral-health program integrity. A registered nurse pleaded guilty in connection with a $14 million healthcare fraud scheme involving mental-health services that were never provided or...
by Blog Master | Sep 22, 2026 | MarketingBlog, Uncategorized
CMS announced on September 22 that it is canceling approximately 315,000 unauthorized Marketplace enrollments covering more than 760,000 individuals. They expect this will return roughly $2.2 billion in subsidies. CMS says its response includes coordinated data...
by Blog Master | Sep 19, 2026 | MarketingBlog, Uncategorized
Payment integrity doesn’t become proactive by adding more tools. It becomes proactive when leaders can actually see what’s happening across the program. A recent Fierce Healthcare article gets at a challenge we see often: payers may have internal tools, outsourced...
