Improper payments in the Medicaid universe are payments full or partial claims payments paid in error or payments made to the wrong party. Improper payments have been a major problem for Medicaid in recent years and have cost the program's valuable resources. Across all government programs, improper payments have...
Syrtis Solution's May 2020 Medicaid News Recap: A roundup of Medicaid news, legislation, and industry developments relating to Medicaid integrity, cost avoidance, improper payments, fraud, waste, and abuse. New York and Ohio make moves toward allowing pharmacists to bill Medicaid for COVID-19 testing APhA, May 30 The...
Introduction Rising prescription drug costs continue to plague state budgets. As states have expanded Medicaid, their enrollments have risen, as has their spending on Medicaid prescription drug benefits. Regardless of whether a state has expanded Medicaid per the Affordable Care Act (ACA), states are currently facing...
Syrtis Solution's March 2020 Medicaid News Recap: A roundup of Medicaid news, legislation, and industry developments relating to Medicaid integrity, cost avoidance, improper payments, fraud, waste, and abuse. Medicare And Medicaid Administrator Addresses U.S. Health Care Response To COVID-19 npr, March 31NPR's Mary Louise Kelly speaks with...
After COVID-19 was declared a national emergency on March 13th, the Centers for Medicare and Medicaid Services (CMS) was able to waive stipulations in federally funded programs to help States respond to the pandemic. To date, CMS has approved Medicaid Section 1135 Waivers for 23...
From Carve-Out to Single PDL Back in September, Michigan proposed policy 1936-Pharmacy to carve-out the State’s Managed Medicaid outpatient pharmacy drug coverage and transition to a Fee-for-Service (FFS) model. However, plans to carve-out pharmacy benefits have recently been updated. After considering the policy, the State has...
Syrtis Solution's February 2020 Medicaid News Recap: A roundup of Medicaid news, legislation, and industry developments relating to Medicaid integrity, cost avoidance, improper payments, fraud, waste, and abuse. Minnesota's Medicaid program made up to $29 million in improper payments for duplicate accounts StarTribune, February 25The state...
Medicaid prescription drug spending has been on the rise and some states have opted to carve out prescription drug benefits and transition to a Fee-For-Service (FFS) model. In theory, this delivery system helps states assert their purchasing power to reduce costs and improve oversight. However,...
Last week, the Supreme Court announced that it would review the verdict from Rutledge v. PCMA, a case from Arkansas dealing with the state’s legal right to regulate reimbursements from pharmacy benefit managers (PBMs). Their ruling could significantly impact prescription drug costs and PBM business...
Government healthcare reforms along with reducing prescription drug prices have been at the top of President Donald Trump’s agenda. A feud between the top health officials at HHS is delaying the administration’s healthcare initiatives. Over the past year, tensions have been building between HHS Secretary Alex...