The Government Accountability Office just recently released its updated High-Risk List. The update is part of the biennial High-Risk Series launched in 1990 that identifies government operations vulnerable to fraud, waste, abuse, and mismanagement. The current report marks the twentieth consecutive year that Medicaid has...
Syrtis Solutions sends out a monthly Medicaid news summary to help you stay up-to-date. The monthly summary focuses on developments, research, and legislation that pertains to Medicaid program integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Here is...
Syrtis Solutions publishes a monthly Medicaid news summary to help you stay up-to-date. The monthly summary concentrates on developments, analysis, and legislation that relates to Medicaid integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Here is a summary...
To reduce pharmaceutical drug costs and increase Medicaid transparency, New York's Governor, Kathy Hochul, and the New York Medicaid Redesign Team announced earlier in the year that the state would carve-out the pharmacy benefit from the Medicaid program. After being postponed for two years, the...
In March 2020, under former Governor Cuomo's administration, the New York Medicaid Redesign Team proposed that the state carve-out pharmacy benefits from the Medicaid program because of concerns involving pharmacy spend and provider transparency. The reform essentially changes prescription drug reimbursement from a managed care...
Syrtis Solutions distributes a monthly Medicaid news summary to help you stay up-to-date. The monthly recap highlights developments, research, and legislation that pertains to Medicaid integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Here is a list of...
Since its passage in 1965, the Medicaid program has expanded to become the single largest payer for health care in the United States, costing $671.2 billion in 2020. Because of spikes in enrollment from the pandemic and the present administration's priorities, spending is only projected...
Over the last fifty years, Medicaid has helped deliver health services to the most vulnerable populations in the United States. As member enrollment surges, Medicaid TPL and fiscal responsibility have been problematic. To address these challenges, numerous legislative efforts have occurred to curb fraud, waste,...
The majority of Medicaid improper payments occur because of antiquated data systems that result in eligibility errors. As the Medicaid program has grown, determining primary commercial coverage, also referred to as Third Party Liability (TPL), has become significantly more complicated and challenging. By law, Medicaid...
The Social Security Act, signed into law by President Franklin Roosevelt in 1934, specifies in the statute ยง 1902( a)( 25) of the legislation "...