With the passing of the Trump administration’s spending bill in the House, Medicaid is at the center of the healthcare policy conversation. The program now consumes roughly one-third of most state budgets, placing enormous strain on state finances. Medicaid expansion and pandemic-era policies have driven...
The reported government-wide improper payment rate of 3.97% in 2024 marks the lowest level in over a decade. But beneath the surface lies a complex reality that reveals systemic flaws in how improper payments are calculated and managed. These numbers, far from representing genuine progress,...
Improper payments and fraud remain persistent and costly challenges for Medicaid and other government-funded programs. The GAO defines improper payments as payments that should not have been made or that were made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or...
America's most vulnerable populations rely on Medicaid and Medicare for essential healthcare services. Unfortunately, these programs lose billions of dollars annually due to improper payments. Recently, the Subcommittee on Oversight and Investigations delved into this pressing issue in a pivotal hearing titled "Examining How Improper...
A recent audit by the U.S. Government Accountability Office reveals that the federal government suffered a staggering loss of $236 billion in 2023 due to improper payments. Medicaid and Medicare alone accounted for 43% of these payments, with Medicaid's improper payments reaching $50.3 billion. These...
Medicaid improper payments have caused the healthcare program to be on the Government Accountability Office's High-Risk List since 2003. The GAO's list identifies government-funded programs that involve substantial resources and provide critical services to the public that are vulnerable to fraud, waste, abuse, and mismanagement....
Improper claims payments are costing the Medicaid program billions of dollars every year. A common misconception is that these payments come from fraud and abuse when in reality, the majority stem from prosaic, mundane issues such as eligibility errors and antiquated data systems. Fraud in...
According to federal agency data from PaymentAccuracy.gov and the Office of Management and Budget, the federal government spent an estimated $247 billion in improper payments in 2022. The data also revealed that the Department of Health and Human Services' Medicaid program accounted for the majority...
The Government Accountability Office recently published its updated High-Risk List. The update is part of the biennial High-Risk Series started in 1990 that identifies government operations vulnerable to fraud, waste, abuse, and mismanagement. The recent report marks the twentieth consecutive year that the Medicaid program...
The federal government doled out close to $100 billion in "improper" Medicaid payments in 2021-- accounting for about one-fifth of all Medicaid payments, according to estimates. The figure represents Washington's current accounting of payments that didn't meet the numerous criteria for the Medicaid program, which the...