medicaid Tag

Medicaid Third Party Liability GAO CMS Syrtis Solutions ProTPL TPL OHI

20 Sep Medicaid Third Party Liability Report From GAO

Identifying third party liability continues to be a challenge under the coordination of benefits for Medicaid plans. By law, plans are payers of last resort so whenever beneficiaries have other active coverage (OHI), those third parties should pay first. Currently, Medicaid plans are required to...

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Rx Carve Out Syrtis Solutions Medicaid California

11 Sep CONCERNS OVER CA’s Rx CARVE OUT

California’s Governor, Gavin Newsom, signed an executive order at the beginning of the year to move all pharmacy services for Medi-Cal from managed care to a FFS model. The consolidated purchasing power would leverage the state’s population size to negotiate drug prices with pharmaceutical...

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Medicaid Improper Payments Syrtis Solutions DHHS

29 Aug MEDICAID IMPROPER PAYMENTS IN FY 2018

DHHS has released its annual Agency Financial Report for FY 2018. The report provides an overview of improper payments in the Medicaid program, root causes for the payments, and corrective actions. In line with the agencies goal of reforming, strengthening, and modernizing the nation’s healthcare...

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DHCS FFS Syrtis Solutions Prescription Drug Costs Medicaid

20 Aug DHCS SEEKS FFS Rx BENEFIT MANAGEMENT

In January, California’s newly elected Governor, Governor Gavin Newsom signed an executive order to drastically reform health care in the state. Executive Order N-01-19 introduced a number of actions and budget proposals to reduce the cost of prescription drugs and health care. One measure, in...

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Medicaid cost avoidance Syrtis Solutions improper payments medicaid fraud waste and abuse

30 Jul COST AVOIDANCE TECHNOLOGY SOLUTIONS FOR MEDICAID

In addition to rising health care costs and increased spending from the program’s expansion, Medicaid is losing billions of dollars a year from improper payments. Protecting the integrity of the Medicaid program has become a top priority for the Centers for Medicare and Medicaid Services...

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Medicaid cost avoidance

23 Jul MEDICAID COSTS PUT EMPHASIS ON RECOVERY EFFORTS

In 1965, Title XIX of the Social Security Act established the Medicaid program to provide health care coverage to low-income individuals. Over time it has developed into one of the nation's largest payers for health care, covering one out of five Americans. In FY 2017,...

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28 Jun CMS AUDITS OVER MEDICAID IMPROPER PAYMENTS

Recent reports from the HHS OIG and the Louisiana Auditor General have indicated a high rate of Medicaid improper payments due to incorrectly determining Medicaid eligibility. The Senate Finance Committee wrote CMS on March 1st to inform the agency of their concerns over the...

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HB 3388

17 May HB 3388 SEES SIGNIFICANT CHANGES

2019 has been a busy year for healthcare legislation in Texas and one bill, in particular, aimed to carve out PBM’s entirely. House Representative J.D. Sheffield (R) introduced HB 3388 on March 6th in an attempt to reform the delivery of prescription drugs to a...

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Syrtis Solutions

17 Apr THE IMPACT OF MEDI-CAL’S PHARMACY CARVE OUT

At the beginning of the year, California’s governor signed an executive order directing DHCS to adopt a fee-for-service model for Medi-Cal. Under the order, California would consolidate its purchasing power and leverage the state’s population size to achieve lower drug costs by purchasing in...

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