GAO REPORT REINFORCES URGENCY OF TACKLING MEDICAID IMPROPER PAYMENTS

 

In August 2025, the Government Accountability Office (GAO) published GAO-25-108067, outlining 32 open priority recommendations for the Department of the Treasury. The report highlights several systemic challenges facing federal agencies, with the foremost being the need to reduce fraud and improper payments.

The GAO estimates that between $233 billion and $521 billion is lost each year due to fraud. Since 2003, improper payments reported across government programs have totaled nearly $2.8 trillion, with Medicaid consistently among the leading drivers of these errors. For the past seven years, improper payments have topped $150 billion annually.

To curb these losses, the GAO called on the Treasury and the OMB to:

• Expand fraud estimation models and leverage analytics in high-risk programs, such as Medicaid.

• Strengthen recovery audits and post-payment reviews to identify and reclaim erroneous disbursements.

• Direct resources toward the riskiest programs, with Medicaid prominently on that list.

GAO cautioned that as time passes, recovering overpayments becomes increasingly unlikely.

Medicaid’s Billion Dollar Problem

The findings align with the analysis presented in Syrtis Solutions’ white paper, "Improper Payments: Medicaid’s Billion-Dollar Problem." Improper payments in Medicaid often result from:

• Errors in eligibility and enrollment

• Incomplete coverage verification

• Coordination of benefits (COB) breakdowns

While the GAO emphasizes corrective steps after payments are made, Syrtis Solutions highlights the measurable value of preventing improper payments upfront. Through its ProTPL solution, Syrtis provides real-time access to verified other health insurance (OHI) and third-party liability (TPL) information. This enables managed care organizations (MCOs) to avoid paying claims that are the responsibility of other third parties, thereby reducing the likelihood of improper payments.

Strengthening Medicaid Program Integrity

Improper payments have long undermined Medicaid’s financial integrity. The GAO’s report underscores the urgency for the Treasury and OMB to enhance oversight, but there is also a clear role for states and MCOs to act immediately.

Data-driven strategies such as proactive COB and TPL detection have delivered ROI ratios above 15:1, preventing millions in unnecessary Medicaid expenditures while protecting funds for eligible members.

GAO’s 2025 report makes clear that improper payments remain a systemic issue across federal programs. Medicaid, as one of the most significant sources of vulnerability, requires both strong federal oversight and the adoption of proactive solutions at the plan level. With proven tools like ProTPL, Syrtis Solutions continues to help states and MCOs safeguard Medicaid funds, improve accuracy, and achieve sustainable savings.

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