URGENT ACTION NEEDED: PROTECT MEDICAID FUNDING BY ELIMINATING IMPROPER PAYMENTS

With billions of dollars in Medicaid funding on the chopping block due to the latest House budget proposal, state programs and Managed Care Organizations (MCOs) are facing an urgent challenge. To safeguard critical healthcare services, Medicaid agencies must take proactive steps to maximize every dollar. One of the biggest opportunities for savings lies in addressing improper payments—an issue that costs Medicaid more than $80 billion each year.

The Costly Problem: Inefficient Medicaid Payments

For nearly two decades, Medicaid’s improper payments have placed it on the Government Accountability Office’s (GAO) high-risk list. While fraud is often blamed, the real issue lies in outdated data systems and inefficient coordination of benefits (COB).

Medicaid is legally required to be the payer of last resort, meaning any other available health coverage should be billed first. However, structural inefficiencies make this difficult:

• Unidentified Third-Party Liability (TPL): Over 13% of Medicaid enrollees have unreported private insurance, leading to Medicaid covering costs that should have been paid by other insurers.
• Outdated and Fragmented Eligibility Data: Medicaid’s eligibility information is scattered across multiple databases, making it difficult to verify primary coverage before paying claims.
• The Ineffective “Pay and Chase” Model: Medicaid agencies attempt to recover improper payments after they occur, but only a small fraction of lost funds are ever recouped.

With Medicaid budgets under intense pressure, continuing this cycle of waste is no longer an option. Addressing these inefficiencies is critical to protecting the program’s financial stability.

The Solution: Proactive Cost Avoidance

Instead of paying claims incorrectly and then trying to recover funds later, Medicaid agencies and MCOs must adopt a cost avoidance approach—ensuring that primary payers are identified and billed before Medicaid covers any claims. This requires real-time access to accurate eligibility data that allows for proper coordination of benefits from the start.

Syrtis Solutions provides a proven, effective solution through ProTPL, a cutting-edge technology that utilizes ePrescribing data—one of the most accurate and timely sources of commercial insurance information—to:

✔ Identify up to 40% more TPL cases than current methods.
✔ Provide real-time OHI data at the point of claim submission, ensuring improper payments never happen.
✔ Eliminate the costly and inefficient “pay and chase” process, reducing administrative waste and financial losses.

Why Immediate Action is Critical

With Medicaid funding at risk, states and MCOs cannot afford to delay. Every improper payment represents lost funding that could have been directed toward patient care. Without intervention, Medicaid agencies will face deeper financial challenges, limiting their ability to provide essential services.

Cost avoidance is no longer just an operational improvement—it is a necessary step to ensure Medicaid’s survival in the face of budget cuts. Syrtis Solutions offers an immediate, effective, and scalable solution to reduce waste and stretch Medicaid dollars further.

Take Control of Medicaid’s Future—Act Now

The time for action is now. Protect Medicaid funding before budget cuts force difficult decisions.

Contact us today at info@syrtissolutions.com to learn how ProTPL can help your organization save millions and secure the future of Medicaid funding.

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