Syrtis Solutions sends out a monthly Medicaid news recap to help you stay up-to-date. The monthly recap focuses on developments, research, and legislation that relates to Medicaid integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Here is a...
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...
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...
Dependence on the Medicaid program has increased exponentially over time. Currently, it is the single largest insurer in the United States, and in 2019, it accounted for more than half of all federal funds distributed to states. Regrettably, as the safety net program has grown,...
Medicaid currently fails at providing a system that efficiently and accurately saves and utilizes member data. As Medicaid is a joint state and federally managed program, there are many issues with coordinating data platforms. Different states have their own unique data processing and storing, and...