Overview
Serving low-income members who often face challenges related to health equity and social determinants of health, Medicaid plans face some of the greatest difficulties in healthcare. Not only do they typically operate on thin margins, they also have an obligation to protect the funding they receive from taxpayers by staying vigilant against inappropriate expenditures. With the latest reported Medicaid improper payment rate reaching 8.58% according to the Centers for Medicare & Medicaid Services (CMS), Medicaid plans are also particularly vulnerable to inappropriate claims submitted by bad actors looking to exploit their members and their payment policies.