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...
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...
In August, the GAO submitted a report to Congress that focused on what CMS would need in order to better target risks and improve Medicaid oversight. The review determined that one of the critical problems the agency is facing is the failure to implement new...
In 2017, improper payments within the Medicaid program reached a total of $37 billion, according to CMS. That equals 10 percent of the federal dollars spent on the program. Moreover, 99.2 percent of the payments made were overpayments. To make matters worse, under the current...
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...
From the very start of Donald Trump’s presidency, he has promised to give states the flexibility they need to craft their own Medicaid policies. HHS, working with governors and state legislatures, could make dramatic state-by-state changes to Medicaid using section 1115 waivers allowed under federal...
The Center for Medicare and Medicaid Services recently released a Medicaid Scorecard to promote transparency and accountability. The scorecard consists of care quality data from 2015 statistics provided by participating states, along with federally reported information. By consolidating this data, CMS and the states look to...
The repeal of the Affordable Care Act with its current provisions for Medicaid did not materialize at the federal level last year; however, states are exploring reform individually by way of Medicaid 1115 waivers. These waivers focus on priorities within the states and permit local governments...
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...
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...
