In 2024, Medicaid improper payments surged to $31.1 billion, placing enormous pressure on state budgets and threatening the program’s stability. A disproportionate share of these losses came from claims Medicaid should never have paid in the first place—claims that were the responsibility of commercial insurers. At any given time, roughly 1 in 10 Medicaid beneficiaries have unreported commercial coverage. States attempt to uncover this through traditional coordination of benefits efforts, but these processes rely on incomplete eligibility data, outdated technology, and fragmented verification workflows. Without accurate, timely information about other health insurance, Medicaid ends up paying incorrectly. Then it must rely on inefficient recovery efforts that rarely recoup more than a fraction of the original loss. Every improper payment diverts resources away from the people Medicaid is meant to serve, and most of these losses are entirely preventable when other coverage is identified before the claim is paid.
THE BIG BEAUTIFUL BILL: WHY THE RISK IS ABOUT TO GET WORSE
Upcoming federal changes under the Big Beautiful Bill will intensify financial pressure on Medicaid programs and make precise identification of third-party liability (TPL) more critical than ever. The legislation introduces broad constraints on Medicaid financing, including:
- Tighter eligibility caps
- New limits on states’ ability to raise revenue
- Hard choices between supplementing Medicaid budgets or cutting essential services
As budgets tighten and coverage needs grow, cost avoidance becomes not just a best practice—but a necessity. Ensuring Medicaid pays only what it should, and shifts primary responsibility to commercial coverage when appropriate, is essential to protecting the program’s future.
SYRTIS SOLUTIONS: STOP WASTE BEFORE IT HAPPENS
Syrtis Solutions addresses this challenge by enabling states to stop waste before it happens. ProTPL, its real-time cost-avoidance technology, identifies previously unknown commercial coverage before Medicaid pays the claim by leveraging exclusive access to the nation’s most extensive ePrescribing infrastructure. Medicaid programs that implement ProTPL typically uncover significantly more commercial coverage, often around 25% more than traditional TPL vendors—while reducing their dependence on costly pay-and-chase recovery methods. This shift generates immediate and sustainable savings because dollars stay within the Medicaid program rather than being lost and pursued later.
Health plans choose Syrtis because the solution is fast to implement, requires no operational disruption, and helps meet federal TPL requirements without placing extra burden on administrative teams. ProTPL works alongside existing vendors, uses a transaction-based pricing structure, and is already trusted by major payers across the country. For states navigating eligibility volatility, revenue restrictions, and mounting improper payments, it offers a practical way to protect budgets, preserve provider networks, and strengthen overall program integrity.
DISCOVER HIDDEN SAVINGS
To help Medicaid payers understand how much they could be saving, Syrtis provides a free claims analysis. Using the plan’s own data, this analysis highlights where current processes fall short and reveals actionable savings opportunities that might otherwise go unnoticed. For Medicaid programs under growing financial pressure, uncovering these insights early can make a measurable difference in both short-term stability and long-term sustainability.
