The Government Accountability Office (GAO), the watchdog for the U.S. Congress, determined that Medicaid and Medicare as programs with potential for a high risk of abuse, waste and fraud. In the case of Medicaid, the GAO says inadequate fiscal oversight might result in improper expenditures....
Syrtis Solutions is pleased to be an exhibitor and presenter at the 2013 Anti-Fraud Exposition coordinated by the National Health Care Anti-Fraud Association. Established in 1985 by multiple private health insurers and federal and state government executives, the National Health Care Anti-Fraud Association is definitely...
A September 2001 report entitled “Medicaid Recovery of Pharmacy Payments by Liable Third Parties” by the U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG), who is charged with protecting healthcare cost containment and the integrity of HHS programs, found that...
In September 2006, after the Deficit Reduction Act of 2005 (DRA) was signed into law, the Government Accountability Office (GAO), which is the investigative arm of the U.S. Congress established to support Congress in improving performance and accountability of the federal government to the nation’s...
A January 2013 report on healthcare cost containment from the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) entitled Medicaid Third-Party Liability Savings Increased, But Challenges Remain describes a substantial increase in the collection of third-party liability (TPL)...
In the previous postings, we discussed the three main "practices" states should adopt in order to cost avoid and save taxpayer money. For states to have a truly effective TPL plan, timely discovery of any additional coverage is needed at the time of Medicaid enrollment....
Put Some Sense into Processing Claims in a Timely Manner The practice of an MCO or Medicaid billing a health insurance provider is backwards. It’s really the responsibility of the commercial insurer to make the initial payment, so that insurance claims are not delayed, which is...
This is the second post in a three part series in which we discuss what steps states should follow to develop an effective TPL plan. In part one, we discussed the need for insurers to cooperate in the active identification of other coverage. In this...
For any state to gain an effective TPL plan, immediate and effective discovery of additional coverage is needed at Medicaid enrollment. Also, cost avoidance discovery must take on immediacy when claims are made and past mistakes need to be solved quickly. What works best is...
The Social Security Act, signed into law by President Franklin Roosevelt in 1934, stipulates in the statute § 1902(a)(25) of the law “…that the State or local agency administering such plan will take all reasonable measures to ascertain the legal liability of third parties…to pay...
