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, particularly through heightened audits of healthcare providers. As DOGE representatives gain access to key systems
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Welcome to the Wonderland of Medicare Audits: AI Takes the Reins!

In the ever-evolving world of Medicare audits, 2025 is shaping up to be a year of Alice’s wonderland. Enter stage right: Artificial Intelligence (AI), a sleek, analytical wonderland where data reigns supreme and human error is no longer allowed to slip through the cracks. If you’ve ever found yourself lost in the tangled forest of…
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 to ensuring the integrity of these programs, can be stressful, complex, and costly. However, many…
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, the state known for its questionable attempts at chili and a certain football team that…
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 & Medicaid Services (CMS), looking at you with the intense scrutiny of a lifeguard watching…
A Major Step Toward Tackling Small Dollar Medicare and Medicaid Fraud

Many smaller providers believe that they are too small for the government to investigate them. Small providers may think that the small amount that they bill Medicare and Medicaid would not catch the governments’ eyes. Which may or may not give them courage to misbill or upcode, according to the government. However: small providers beware.…
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 letter arrives from a government auditor, summoning a healthcare provider to account for their billing…
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 recent years, and several key trends are expected to shape the landscape in 2025. These…
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 Bar asked for attorney volunteers to appeal FEMA denials. I figured FEMA denials must be…
RAC Overpayment Allegations Versus FCA Accusations: The Importance of Whom and Scienter
I am so happy to be here. For those of you who watched the live version of last week’s Monitor Monday, I suffered a seizure during my segment. I am so thankful to Dr. Hirsh for recognizing the signs and calling my administrative assistant, who normally would never interrupt my presentation, but for his call.…