The Problem

We estimate that Medicaid improper payments exceed $57 billion a year, primarily due to program ineligibility, errors, or a lack of medical necessity.

Estimated 2016 TOTAL MEDICAID EXPENDITURES

$566 Billion

Sources: CMS.gov; paymentaccuracy.gov; Verus estimates

Our Solution

We are currently beta testing Verus Health Services and expect to make it broadly available to state agencies by Q4, 2018. Please contact us if you are interested in participating in a pilot project.

Capabilities

Medicaid eligibility determination

We estimate that up to a third of all Medicaid recipients are ineligible at any given time, often because they’ve exceeded income limitations or moved out of state. With our A.I.-based data matching capabilities and exclusive access to proprietary financial databases, we’re able to assess a beneficiary’s means and state-of-residence on a monthly basis, increasing both the accuracy and frequency of eligibility determinations.

Medicaid TPL Pay & Chase recovery

Each year, we estimate that more than $8 billion in Medicaid TPL reimbursement claims issued to health care payors are never responded to or paid (85% of all claims). On behalf of state Medicaid agencies and their contract managed care organizations, we can apply the same technology and methodology we’ve successfully used in large multi-state unclaimed property audits in order to pursue unpaid TPL claims.

Interested in learning more about Verus Health Services?

Contact us at verushealthservices@vanalytics.com