The Government Accountability Office just recently released its updated High-Risk List. The update is part of the biennial High-Risk Series started in 1990 that identifies government operations susceptible to fraud, waste, abuse, and mismanagement. The recent report marks the twentieth consecutive year that Medicaid has...
Syrtis Solutions issues a monthly Medicaid news recap to help you stay up-to-date. The monthly summary focuses on 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...
Syrtis Solutions distributes a monthly Medicaid news roundup to help you stay informed. The monthly recap highlights developments, research, and legislation that relates to Medicaid integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Below is a summary of...
To reign in prescription drug costs and increase Medicaid program transparency, New York's Governor, Kathy Hochul, and the New York Medicaid Redesign Team announced earlier this year that the state would carve-out the pharmacy benefit from the Medicaid program. After being delayed for two years,...
In March 2020, under former Governor Cuomo's administration, the New York Medicaid Redesign Team advised that the state carve-out pharmacy benefits from the Medicaid program due to concerns pertaining to pharmacy spend and provider transparency. The reform fundamentally transitions prescription drug reimbursement from a managed...
Syrtis Solutions publishes a monthly Medicaid news summary to help you stay informed. The monthly recap concentrates on developments, analysis, and legislation that pertains to Medicaid program integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Here is a...
Since its passage in 1965, the Medicaid program has grown to become the single largest payer for health care in the United States, costing $671.2 billion in 2020. Because of surges in enrollment from the pandemic and the present administration's priorities, spending is only projected...
Over the last 56 years, Medicaid has helped deliver health services to the most vulnerable populations in the United States. As member enrollment surges, Medicaid TPL and fiscal accountability have been problematic. To resolve these challenges, numerous legislative efforts have taken place to curb fraud,...
The vast majority of Medicaid improper payments occur because of antiquated data systems that result in eligibility errors. As the Medicaid program has grown, finding primary commercial coverage, also referred to as Third Party Liability (TPL), has become increasingly more complicated and challenging. By law,...
The Social Security Act, signed into law by President Franklin Roosevelt in 1934, stipulates in the statute ยง 1902( a)( 25) of the legislation "...