Payment prevention is becoming a defining priority across Medicaid program integrity. Federal agencies continue to expand fraud enforcement, while Congress has strengthened financial accountability through the One Big Beautiful Bill Act (H.R. 1). Together, these developments reflect a broader shift in Medicaid—from emphasizing post-payment recovery...
Stephen Konsin Jr. from Syrtis Solutions, a solution provider at the Marcus Evans Value-Based Care Summit 2026, discusses the growing need for proactive Medicaid payment accuracy and cost avoidance strategies. Interview with: Stephen Konsin Jr., Vice President of Sales, Syrtis Solutions “The window for demonstrating proactive prevention...
As states begin outlining fiscal year (FY) 2027 Medicaid budgets, many programs are confronting a tighter and less predictable financial environment. State revenue growth has cooled, healthcare costs remain elevated, and federal policy changes enacted through the 2025 budget reconciliation law have reshaped how funding...
Medicaid, the largest public health insurance program in the United States, is under scrutiny, not for its mission, but for its costs. What started as a vital safety net has grown into a massive budget line item for nearly every state. With Medicaid now accounting...
With the latest House budget proposal threatening to cut billions from Medicaid, state programs and Managed Care Organizations (MCOs) face an urgent challenge. To sustain healthcare services and maximize every dollar, Medicaid agencies must take immediate action to reduce financial waste. One of the most...
The reported government-wide improper payment rate of 3.97% in 2024 represents the lowest level in over a decade. But below the surface lies a complicated reality that exposes systemic flaws in how improper payments are calculated and managed. These numbers, far from representing genuine progress,...
Improper payments and fraud remain chronic and costly difficulties for Medicaid and other government-funded programs. The GAO defines improper payments as payments that should not have been made or that were made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or...
The nation's most vulnerable populations rely upon Medicaid and Medicare for essential healthcare services. Regrettably, these programs lose billions of dollars each year as a result of improper payments. Recently, the Subcommittee on Oversight and Investigations explored this pressing issue in an essential hearing titled...
A new audit by the GAO indicates that the government suffered a significant loss of $236 billion in 2023 as a result of improper payments. Medicaid and Medicare alone accounted for 43% of these payments, with Medicaid's improper payments reaching $50.3 billion. These findings highlight...
Medicaid improper payments have caused the safety net program to be on the Government Accountability Office's High-Risk List since 2003. The GAO's list identifies government programs that involve considerable resources and offer vital services to the public that are prone to fraud, waste, abuse, and...