The 340B Drug Pricing Program, created by the U.S. federal government in 1992, is a critical healthcare initiative designed to help low-income and underserved communities gain access to affordable medications. It mandates that drug manufacturers provide outpatient drugs to certain
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A Titanic Shift at CMS: The Push to Trim Administrative Costs and Increase Audits

The Centers for Medicare and Medicaid Services (CMS), the linchpin of America’s healthcare economy, is about to undergo significant changes under scrutiny from Elon Musk’s Department of Government Efficiency (DOGE). This shift could impact how CMS administers Medicare and Medicaid,…
Welcome to the Wonderland of Medicare Audits: AI Takes the Reins!
Defending Against Medicare and Medicaid Audits: A Guide for Healthcare Providers
Medicare and Medicaid audits are an inevitable part of the healthcare landscape. With the increasing demand for healthcare services and a growing focus on reducing federal spending, providers can find themselves under scrutiny for alleged overpayments. These audits, while essential…
Ohio Decides to Raise Medicaid Reimbursement Rates. Now, If Only Other States Followed Suit…
Ohio, in its infinite wisdom, has decided to take a bold step forward in healthcare by raising its Medicaid reimbursement rates. And when I say “bold,” I mean “a historic, mind-blowing $3.4 billion per year” kind of bold. That’s right—Ohio,…
Scrutiny for Reactivating Medicare Providers and Reimbursement Rates for “Swing Beds”
Picture this: you’re a healthcare provider who’s been out of the Medicare game for a while, maybe took a little break to recharge, and now you’re ready to dive back into the waters of reimbursement. Enter the Centers for Medicare…
A Major Step Toward Tackling Small Dollar Medicare and Medicaid Fraud
Medicare and Medicaid Provider Audits: Are You on the Naughty List?
As the holiday season rolls in, so too does the festive spirit of Medicare and Medicaid provider audits. Imagine this: the snow is gently falling, Christmas lights twinkle on every house, and in the midst of the holiday cheer, a…
2025 and AI: The Future of Medicare and Medicaid Provider Audits

The Medicare and Medicaid provider auditing process is about to get its own makeover in 2025. I am talking about artificial intelligence, which will be more accurate than our auditors pre-2025. The Medicare provider auditing process has evolved significantly in…
CMS Policies: One Size Does Not Fit All
This past Friday I drove to Avery County, which is in western NC to provide a day of pro bono services for the victims of Hurricane Helene. Apparently, FEMA is denying applications based on flooding not being covered. The NC…