Imagine a prosecutor who files charges, seizes the defendant’s assets before trial, and then never appears in court. No opening…

Federal Medicare enforcement continues to accelerate. CMS seems to be deploying more contractors, broader audit authority, and sharper analytics than…

I want to celebrate a recent win and provide a warning.

When a state agency suspends a healthcare provider’s Medicaid…

Every provider who bills Medicare has felt the sting of a denied claim. Some denials are one-off mistakes — a…

The government has wound care in its crosshairs. The HHS Office of Inspector General published a September 2025 report titled…

It usually starts with a letter. A managed care organization (MCO), a Recovery Audit Contractor (RAC), or a Unified Program…

The numbers are hard to ignore. The use of AI has substantially increased the number of audits over health care…

In Home Health, LLC v. Robert F. Kennedy, Jr., No. 25-3542 (6th Cir. July 27, 2026). Published for Binding…

The Centers for Medicare & Medicaid Services (CMS) Medicare Fee-for-Service Recovery Audit Program continues to operate through contracted Recovery Audit…

The Recovery Audit Contractor (RAC) program was designed to identify and correct Medicare improper payments, but for years it operated…

RACs and UPICs have become one of the most burdensome—and least accountable—mechanisms in the Medicare reimbursement system. Armed with contingency-fee…

Under 42 C.F.R. § 422.214(a)(1), a noncontract provider that furnishes services to an MA enrollee must accept as payment…