The CMS has witnessed a dramatic surge in improper Medicaid payments and says the Affordable Care Act could be the cause. The Medicaid improper payment rate has jumped from 5.8% or $14.4 billion in fiscal 2013 to 9.78% or $29.12

Last month Congress held a hearing concerning the escalating number of improper payments in Medicare and Medicaid. The House oversight panel reviewed concerns regarding escalating improper payment rates discovered by federal oversight groups which include the Government Accountability Office (GAO) and

When ProTPL discovers other health insurance, you can reverse the latest claim and ensure that future claims, whether pharmacy or medical, aren’t paid in error. Discovering other health insurance fast, triggered by Pharmacy claims, allows you to intercept the medical

Federal agencies issued an assessed $136.7 billion in incorrect payments during fiscal year 2015, the greatest yearly tally since 2004 when agencies first began reporting data on the subject. As in past years, the Medicare and Medicaid programs accounted for

Government expenditures for Medicaid managed care embodied more than one-third of the total government Medicaid spending in 2014, according to a government report (GAO-16-77) released Jan. 19 that highlights exactly how states are increasingly relying on managed care as they

A GAO report uncovered data that the government accumulated more than $124 billion in improper payments in 2014, $19 billion more than the year before. The Oct. 1 report uncovered that the outpouring in payments came almost entirely from Medicare and

In September, The Globe Gazette reported that Iowa representatives have turned in waiver requests with the federal government as a part of Gov. Terry Branstad's strategy to switch Medicaid to a privately run managed care system effective Jan. 1 - a

There are many ways during Medicaid enrollment and claims processing to identify if a member has primary coverage. The discovery of other health information occurs in three points; during the application process, prospectively when claims are processed, and post-payment (Pay

Why GAO Did This Study During fiscal year 2013, Medicaid - collectively funded by states and the federal government - delivered health care insurance coverage to over 70 million people at an overall cost of about $460 billion. Our lawmakers

Recently, I got into a discussion with a state Medicaid TPL director about RFPs for third party liability cost avoidance work. I feel that our cost avoidance solution would greatly benefit state-run plans, but RFPs are nearly always written for a single vendor