Medicaid

Syrtis Solutions Improper Payments CMS Trump

26 Oct PREVENTING IMPROPER MEDICAID PAYMENTS

Of the $4 trillion spent by the government in 2017, nearly $141 billion were improper payments. These are payments made in error either to the wrong recipient, in the incorrect amount, or for a service that is not legitimate. Fraud, antiquated data systems, and methodologies...

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09 Oct HEALTHCARE MEGA-MERGERS

Over the last year, there has been a wave of PBM and healthcare provider mega-mergers. These acquisitions have undergone intense review and the approvals suggest that government regulators are more comfortable with vertical integration as opposed to horizontal. Here is an overview of these mergers. CVS...

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Medicaid Expansion Map

17 Jul Medicaid Expansion Has Improved Access To Quality Care

While Medicaid expansion supporters are pleased with the recent developments in Maine and Virginia, there are concerns about the access to quality care as the Medicaid population expands.  To address these concerns, a number of studies have been conducted to help guide the states considering...

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Medicaid Drug Costs

03 May The Soaring Cost of Drugs for the Medicaid Program

Last month, President Trump delayed presenting his plan to address the soaring costs of prescription drugs. Despite the delay, New York’s Medicaid Drug Utilization Review Board (DURB) took it upon themselves to negotiate with drug manufacturers. DURB voted in favor of lowering the price its...

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Medicaid Payment Intergrity

16 Apr Billions Lost Due To Improper Medicaid Payments

Medicaid is losing billions of dollars from improper payments. According to HHS Agency Financial Reports, improper Medicaid payments reached $30 billion in 2015 and grew to almost $37 billion in 2017. The vast majority of these improper payments were determined to be improper claims payments...

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