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...
Support for Medicaid expansion is on the rise as states approach general elections this fall. Advocates for expansion have been busy in recent months as they look to expand their programs by way of ballot initiatives. In May we reviewed a number of states considering...
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...
After months of debate amongst Republican representatives in both the House and Senate, legislators in Virginia voted in favor of Medicaid expansion under the ACA on May 30th, 2018. The provision to expand the state's Medicaid program to over 400,000 Virginia residents was included in the...
It has been six weeks since Virginia's General Assembly met for a special session to produce the state's budget for FY 2019 and decide the fate of Medicaid expansion. On Tuesday, the Finance Committee met but Virginia Senate Republicans delayed a decision on a proposed...
