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...
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...
Payment integrity programs are designed to provide correct claims processing, adherence to contractual rates, and compliance with payment rules. These efforts are essential for maintaining the financial stability of healthcare systems and making certain that patients receive proper care. That being said, they can create...