Syrtis Solutions distributes a monthly Medicaid news summary to help you stay up-to-date. The monthly roundup focuses on developments, research, and legislation that relate to Medicaid program integrity, cost avoidance, coordination of benefits, improper payments, fraud, waste, and abuse. Below is a summary of last month’s Medicaid news.
Protecting essential services by eliminating waste in Missouri Medicaid Missouri Independent, February 28
If you polled Missourians, you would be hard-pressed to find someone who enjoys paying taxes, regardless of political affiliation. Yet most Missourians recognize that some services are essential — things like roads, schools, and programs that support independence, self-sufficiency and community health. These services provide stability not just for individuals, but for entire communities. The expectation is simple: if tax dollars must be spent, they should be spent wisely. As physicians, our mission is to help people live healthier lives. read more
If you polled Missourians, you would be hard-pressed to find someone who enjoys paying taxes, regardless of political affiliation. Yet most Missourians recognize that some services are essential — things like roads, schools, and programs that support independence, self-sufficiency and community health. These services provide stability not just for individuals, but for entire communities. The expectation is simple: if tax dollars must be spent, they should be spent wisely. As physicians, our mission is to help people live healthier lives. read more
STRENGTHENING MEDICAID PROGRAM INTEGRITY
Syrtis Solutions, February 27
Medicaid integrity is crucial for administrators and leaders at state agencies that manage one of the nation’s largest and most vital safety-net programs. Every day, their teams process eligibility determinations, adjudicate claims, and deliver care to millions of people. With joint federal-state funding exceeding hundreds of billions annually and expected budget reductions, the stakes for accuracy have never been higher. Strong program integrity isn’t about suspicion—it’s about ensuring every dollar reaches the right person, at the right time, for the right reason. When integrity is robust, public trust grows, administrative burdens shrink, and eligible individuals receive uninterrupted support.
read more
Syrtis Solutions, February 27
Medicaid integrity is crucial for administrators and leaders at state agencies that manage one of the nation’s largest and most vital safety-net programs. Every day, their teams process eligibility determinations, adjudicate claims, and deliver care to millions of people. With joint federal-state funding exceeding hundreds of billions annually and expected budget reductions, the stakes for accuracy have never been higher. Strong program integrity isn’t about suspicion—it’s about ensuring every dollar reaches the right person, at the right time, for the right reason. When integrity is robust, public trust grows, administrative burdens shrink, and eligible individuals receive uninterrupted support.
read more
Audit finds $24.3M in unallowable Medicaid payments in Utah
KSL.com, February 26
The Utah Office of Inspector General estimates that $24 million was spent in Medicaid payments that were not allowed due to overlapping enrollment in multiple states, according to a recent audit. These unallowable payments are due to delayed interstate benefit match updates and unclear policies, the office said Wednesday. The office cited an audit done by the U.S. Department of Health and Human Services Office of Inspector General, which focused on whether Utah Medicaid made payments to beneficiaries who were also receiving payments through other states’ programs. read more
KSL.com, February 26
The Utah Office of Inspector General estimates that $24 million was spent in Medicaid payments that were not allowed due to overlapping enrollment in multiple states, according to a recent audit. These unallowable payments are due to delayed interstate benefit match updates and unclear policies, the office said Wednesday. The office cited an audit done by the U.S. Department of Health and Human Services Office of Inspector General, which focused on whether Utah Medicaid made payments to beneficiaries who were also receiving payments through other states’ programs. read more
Trump Administration Prioritizes Affordability by Announcing Major Crackdown on Health Care Fraud
February 25, CMS.gov
Today at the White House, Vice President J.D. Vance, Secretary of Health and Human Services (HHS) Robert F. Kennedy, Jr., and Administrator of the Centers for Medicare & Medicaid Services (CMS) Dr. Mehmet Oz announced new steps to crack down on fraud in Medicare and Medicaid to protect patients and taxpayers and improve affordability. The actions include deferring $259.5 million of quarterly federal Medicaid funding in Minnesota to prevent payment of questionable claims while further investigation is completed; a nationwide moratorium on Medicare enrollment for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers; and a nationwide call to action for Americans to support fraud prevention, including stakeholder input on how CMS can continue to expand and strengthen its efforts. read more
February 25, CMS.gov
Today at the White House, Vice President J.D. Vance, Secretary of Health and Human Services (HHS) Robert F. Kennedy, Jr., and Administrator of the Centers for Medicare & Medicaid Services (CMS) Dr. Mehmet Oz announced new steps to crack down on fraud in Medicare and Medicaid to protect patients and taxpayers and improve affordability. The actions include deferring $259.5 million of quarterly federal Medicaid funding in Minnesota to prevent payment of questionable claims while further investigation is completed; a nationwide moratorium on Medicare enrollment for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers; and a nationwide call to action for Americans to support fraud prevention, including stakeholder input on how CMS can continue to expand and strengthen its efforts. read more
Medicaid Plays an Important Role in Providing Health Coverage to Key Populations Center On Budget and Policy Priorities, February 25
Nearly 70 million people with low incomes got their health coverage through Medicaid as of October 2025.[1] The program is a critical source of coverage for many populations, but the Republican megabill, enacted in July 2025, cuts more than $900 billion from Medicaid. According to the Congressional Budget Office, this will cause 7.5 million people to lose Medicaid coverage and become uninsured by 2034.[2] Preserving Medicaid coverage is essential to protecting the health of people across a number of populations, including children, adults, and people with disabilities. Medicaid ensures that people of all ages have access to the health care they need, covering 2 in 5 children, 1 in 6 non-elderly adults, and 1 in 7 seniors nationwide.[3] (See Figure 1.) read more
Nearly 70 million people with low incomes got their health coverage through Medicaid as of October 2025.[1] The program is a critical source of coverage for many populations, but the Republican megabill, enacted in July 2025, cuts more than $900 billion from Medicaid. According to the Congressional Budget Office, this will cause 7.5 million people to lose Medicaid coverage and become uninsured by 2034.[2] Preserving Medicaid coverage is essential to protecting the health of people across a number of populations, including children, adults, and people with disabilities. Medicaid ensures that people of all ages have access to the health care they need, covering 2 in 5 children, 1 in 6 non-elderly adults, and 1 in 7 seniors nationwide.[3] (See Figure 1.) read more
CMS unveils new initiatives aimed at cracking down on healthcare fraud Fierce Healthcare, February 25
The Trump administration announced late Wednesday new steps it says are designed to crack down on fraud. The new push, which comes just one day after President Donald Trump highlighted the White House’s focus on fraudulent behavior across multiple social programs, includes three key prongs. In the first piece, the Centers for Medicare & Medicaid Services (CMS) said it would hold back $259.5 million in Medicaid funding for the state of Minnesota. read more
The Trump administration announced late Wednesday new steps it says are designed to crack down on fraud. The new push, which comes just one day after President Donald Trump highlighted the White House’s focus on fraudulent behavior across multiple social programs, includes three key prongs. In the first piece, the Centers for Medicare & Medicaid Services (CMS) said it would hold back $259.5 million in Medicaid funding for the state of Minnesota. read more
Medicaid copays, audits and more: GOP lawmakers seek to rein in costs, change behavior Kentucky Lantern, February 24
A sweeping Republican bill aiming to reform Kentucky’s Medicaid program would impose copays on some patients, among other changes that advocates say would put up barriers to care. House Bill 2 was approved by the House Appropriations and Revenue Committee Tuesday and can go to the House floor. It would impose new paperwork requirements on nearly 500,000 Kentuckians covered by the Medicaid expansion who would have to regularly demonstrate that they are working or otherwise engaged in the community.
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A sweeping Republican bill aiming to reform Kentucky’s Medicaid program would impose copays on some patients, among other changes that advocates say would put up barriers to care. House Bill 2 was approved by the House Appropriations and Revenue Committee Tuesday and can go to the House floor. It would impose new paperwork requirements on nearly 500,000 Kentuckians covered by the Medicaid expansion who would have to regularly demonstrate that they are working or otherwise engaged in the community.
read more
$28 Billion in Improperly Paid Claims: CMS Reports Biggest Coding Errors MedCentral, February 23
Every time you report Current Procedural Terminology (CPT) code 99233 to Medicare for your high-level hospital visits, you collect about $107. But your Medicare Administrative Contractor (MAC) may be asking for that money back on occasion, considering that the US government says more than 22% of claims for 99233 were upcoded in 2024, causing almost half a billion dollars in overpayments. read more
Every time you report Current Procedural Terminology (CPT) code 99233 to Medicare for your high-level hospital visits, you collect about $107. But your Medicare Administrative Contractor (MAC) may be asking for that money back on occasion, considering that the US government says more than 22% of claims for 99233 were upcoded in 2024, causing almost half a billion dollars in overpayments. read more
Health Insurer Financial Performance in 2024
KFF, February 23
The largest private health insurance companies often offer plans in multiple markets, including the Medicare Advantage, Medicaid managed care, individual (non-group), and fully-insured group (small and large employer) health insurance markets. Each market has unique features, including eligibility, payment, and coverage rules, which affect insurers’ overhead and potential profit. In recent years, private insurers are playing a growing role in public insurance programs, with more than half of eligible Medicare beneficiaries enrolled in a private Medicare Advantage plan and more than three-quarters of Medicaid enrollees obtaining coverage through a managed care plan (typically a private insurer). read more
KFF, February 23
The largest private health insurance companies often offer plans in multiple markets, including the Medicare Advantage, Medicaid managed care, individual (non-group), and fully-insured group (small and large employer) health insurance markets. Each market has unique features, including eligibility, payment, and coverage rules, which affect insurers’ overhead and potential profit. In recent years, private insurers are playing a growing role in public insurance programs, with more than half of eligible Medicare beneficiaries enrolled in a private Medicare Advantage plan and more than three-quarters of Medicaid enrollees obtaining coverage through a managed care plan (typically a private insurer). read more
This State’s Medicaid Payment Errors Are Below The National Average AOL, February 21
Medicaid is the U.S. program that provides free or affordable health coverage to low-income Americans. The program is funded on the federal level by the Centers for Medicare and Medicaid Services (CMS) and by individual states. Many find this to be an inefficient system that results in mismanaged funds and allows states to make improper payments. Every year, millions of dollars meant to help Medicaid beneficiaries are lost to both fraud and seemingly honest mistakes made in the distribution process. read more
Medicaid is the U.S. program that provides free or affordable health coverage to low-income Americans. The program is funded on the federal level by the Centers for Medicare and Medicaid Services (CMS) and by individual states. Many find this to be an inefficient system that results in mismanaged funds and allows states to make improper payments. Every year, millions of dollars meant to help Medicaid beneficiaries are lost to both fraud and seemingly honest mistakes made in the distribution process. read more
Medicaid Managed Care Reporting and Transparency: Managed Care Program Annual Reports KFF, February 18
Comprehensive, capitated managed care is the dominant Medicaid delivery system, accounting for about 78% of beneficiaries (over 66 million individuals as of July 2024) and 50% of total Medicaid spending (over $458 billion in FY 2024). States were contracting with over 280 individual Medicaid managed care organizations (MCOs) (as of July 2022), which represent a mix of private for-profit, private non-profit, and government plans. read more
Comprehensive, capitated managed care is the dominant Medicaid delivery system, accounting for about 78% of beneficiaries (over 66 million individuals as of July 2024) and 50% of total Medicaid spending (over $458 billion in FY 2024). States were contracting with over 280 individual Medicaid managed care organizations (MCOs) (as of July 2022), which represent a mix of private for-profit, private non-profit, and government plans. read more
Maine House Oversight Committee grills DHHS over improper Medicaid payments Fox 23, February 17
The investigation into Maine’s Medicaid program continues after a multi-state audit found millions in improper or potentially improper payments for autism services. “To question the credibility of civil servants is not appropriate,” DHHS Commissioner Sara Gagne-Holmes said. “We are not the ones doing the improper billing.” “But you’re not providing any oversight either, commissioner,” Rep. Chad Perkins (R-District 31) said. “I beg to differ,” Gagne-Holmes said. read more
The investigation into Maine’s Medicaid program continues after a multi-state audit found millions in improper or potentially improper payments for autism services. “To question the credibility of civil servants is not appropriate,” DHHS Commissioner Sara Gagne-Holmes said. “We are not the ones doing the improper billing.” “But you’re not providing any oversight either, commissioner,” Rep. Chad Perkins (R-District 31) said. “I beg to differ,” Gagne-Holmes said. read more
DHS Audit: $1 billion in Medicaid funding vulnerable to fraud
Fox 9, February 6
A third-party audit of the Minnesota Department of Human Services (DHS) identified more than $1 billion in Medicaid funding that may be vulnerable to waste, fraud and abuse. What we know: DHS released the initial findings from an ongoing external audit of how the state is processing Medicaid claims. The audit is being conducted by Optum, a subsidiary of United Healthcare. Optum reviewed four years worth of data from DHS in 14 areas of Medicaid service that have been identified as vulnerable to waste, fraud and abuse.
read more
Fox 9, February 6
A third-party audit of the Minnesota Department of Human Services (DHS) identified more than $1 billion in Medicaid funding that may be vulnerable to waste, fraud and abuse. What we know: DHS released the initial findings from an ongoing external audit of how the state is processing Medicaid claims. The audit is being conducted by Optum, a subsidiary of United Healthcare. Optum reviewed four years worth of data from DHS in 14 areas of Medicaid service that have been identified as vulnerable to waste, fraud and abuse.
read more
Community Health Center Patients, Financing, and Services
KFF, February 4
Community health centers are a national network of nearly 1,400 safety-net primary care providers that served more than 32 million patients in 2024. They are located in medically underserved urban and rural communities and provide comprehensive primary care services to patients regardless of their ability to pay, providing a range of medical, behavioral, and supportive services. read more
KFF, February 4
Community health centers are a national network of nearly 1,400 safety-net primary care providers that served more than 32 million patients in 2024. They are located in medically underserved urban and rural communities and provide comprehensive primary care services to patients regardless of their ability to pay, providing a range of medical, behavioral, and supportive services. read more
