GAO’s Latest Findings on Improper Payments The Government Accountability Office (GAO) released report GAO-25-108067 in August 2025, identifying 32 open priority recommendations for the Department of the Treasury. At the forefront of these recommendations is the reduction of fraud and
Third-party liability, also known as TPL, is the legal obligation of third parties to pay part or all of the expenditures for medical assistance under a Medicaid state plan. In other words, if a beneficiary has other forms of health
Medicaid currently fails at providing a system that efficiently and accurately stores and utilizes member data. As Medicaid is a joint state and federally run program, there are many problems with coordinating data platforms. Different states have their own unique
Medicaid has evolved to become an integral safety net program that provides access to health care for millions of Americans. Payment for this health care is either delegated to Medicaid or other third party insurance coverage. In 2012, 7.6 million
The Social Security Act, signed into law by President Franklin Roosevelt in 1934, specifies in statute § 1902( a)( 25) of the law "... that the State or local agency administering such plan will take all reasonable measures to ascertain
Improper payments cost Medicaid $86.49 billion in 2020 alone. A common misconception is that improper payments come from fraud and abuse when in reality the majority come from prosaic, ordinary problems such as eligibility errors and antiquated data systems. Fraud
Since Medicaid’s inception in 1965, the program has expanded to become the largest provider of healthcare coverage in the country. As the member population size has grown, Medicaid third party liability (TPL) efforts and fiscal responsibility have been reoccurring issues.
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,
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
Since state Medicaid programs are responsible for the healthcare of several populations, skyrocketing prescription drug costs have become a major budgetary concern. Currently, health care spending is dominating many of their budgets and on a per capita basis, inflation-adjusted retail
1601 Rio Grande, Suite 330, Austin, TX 78701
Phone: 866-960-9358
Email: info@syrtissolutions.com
