The federal government spent an estimated $124.7 billion in 2014 inimproper payments across 22 government agencies, most of which came from Medicare and Medicaid programs, according to expert testimony from a senior GAO official.
A group of providers in Alaska is suing a subsidiary of the Xerox Corp., claiming the company botched an install of new Medicaid payment software, the Alaska Daily News has reported.
Medicaid is typically a state's largest centrally managed program, and has significant impact on other healthcare sectors nationwide. But despite the program's complexities, it does not always have the tools to maintain operational success.
Although medical providers are prohibited from billing patients for costs that aren't covered by Medi-Cal, California's low income insurance plan, patient advocates say they are receiving an increasing number of complaints regarding the practice known as balance billing.
More than 12,000 overpayment referrals are sitting untouched in the Nebraska Department of Health and Human Services' "overpayments mailbox," according to a state audit released last week.
As Medicaid accountable care organizations continue to gain traction, their success largely will depend upon states' ability to generate savings and overcome challenges. For the most part, states adopt ACOs for two reasons: To reign in cost-related concerns and to coordinate care across populations.
The use of prescription drugs among Medicaid enrollees often is associated with decreases in other Medicaid costs, mostly in inpatient spending and outpatient spending, according to a recent study.
From March 2011 through September 2013, Washington failed to suspend Medicaid payments to 48 providers being investigated for credible allegations of fraud, according to a report from the Office of Inspector General.
The Obama administration is zeroing in on fraud, waste and abuse, as evidenced by a letter from a White House official calling for "a more aggressive strategy" to combat improper payments within government healthcare programs.
Iowa Gov. Terry Branstad is defending the companies selected to manage the state's $4.2 billion Medicaid program, despite reports that all four have been involved in high-priced fraud settlements, according to the Des Moines Register.