06 Mar MEDICAID IS LOSING BILLIONS-HERE’S HOW TO STOP IT
Medicaid funding is at risk. A new budget proposal in Congress could slash billions from state programs, putting essential healthcare services in jeopardy. To keep Medicaid strong, state agencies and Managed Care Organizations (MCOs) must act now to eliminate wasteful spending and protect every dollar.
One of the biggest drains on Medicaid? Improper payments. Every year, Medicaid loses more than $80 billion by paying claims it shouldn’t—money that could have been used for patient care.
The Problem: Medicaid is Paying When It Shouldn’t
For nearly 20 years, Medicaid has been flagged by the Government Accountability Office (GAO) for its high rate of improper payments. The cause? Outdated systems and poor coordination of benefits, not just fraud.
Medicaid is legally the payer of last resort, meaning if a patient has other insurance, that insurance should pay first. But that isn’t happening due to:
- Unreported Insurance Coverage: More than 13% of Medicaid members have private insurance Medicaid doesn’t know about—leading to unnecessary payments.
- Outdated and Scattered Data: Medicaid’s eligibility systems are fragmented, making it difficult to verify a patient’s primary insurance before paying a claim.
- A Broken Recovery Process: Medicaid attempts to recover improper payments after they’ve been made, but most of the money is never recovered.
With funding cuts looming, Medicaid can’t afford to keep making these costly mistakes.
The Solution: Stop Paying Incorrect Claims in the First Place
Instead of making payments in error and trying to recover them later, Medicaid agencies and MCOs need to prevent mistakes upfront by ensuring private insurers are billed before Medicaid.
Syrtis Solutions provides a proven solution with ProTPL, a cutting-edge technology that uses ePrescribing data—one of the most accurate sources of commercial health insurance information—to:
✔ Identify 40% more third-party liability (TPL) cases than traditional methods.
✔ Deliver real-time insurance data at the point of claim submission, stopping improper payments before they happen.
✔ Eliminate administrative waste, ending the costly “pay and chase” cycle once and for all.
Why This Matters Now
With Medicaid funding under threat, states and MCOs cannot afford to wait. Every dollar wasted on an unnecessary claim is a dollar that could have been used for essential healthcare services.
Cost avoidance isn’t just about efficiency—it’s about ensuring Medicaid’s survival. Syrtis Solutions offers an immediate, effective way to cut waste and protect Medicaid resources.
Take Action Now
Don’t wait for budget cuts to force change. Be proactive. Protect Medicaid.
Contact us today at info@syrtissolutions.com to learn how ProTPL can help your organization save millions and keep Medicaid financially strong.