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Medicaid Is Now Auditing Before It Pays · CareTalk: Healthcare. Unfiltered.

• 0:06
  John: Let's get into a little bit of the, the, the vulnerable population stuff.
• 0:09
  John: A lot of those enterprises that you're selling to are serving Medicare, the, the federal program in the United States for the elderly, and Medicaid, the poor.
• 0:19
  John: What's, as, uh, as we're going through, you know, restructuring, you know, health plans coming in and out of the Medicare managed care program because of V28 and covering different geographies with different kind of benefits, and in Medicaid a lot of people, uh, you know, falling off of coverage and falling off of the exchange.
• 0:37
  John: What's going on in your practices?
• 0:39
  John: What are you seeing happening to vulnerable populations right now?
• 0:44
  Alon: John, I think right now is probably the most, um I would say turbulent times for these population.
• 0:54
  Alon: And let me just give you like three quick headlines.
• 0:57
  Alon: One is we're seeing, you know, Vice President announce, uh,$1.3 billion suspension of Medicaid payments in California.
• 1:06
  Alon: We're seeing fees for Medicare enrollments for, uh, new home healthcare and hospice providers across the country, right?
• 1:15
  Alon: There's a lot of focus, uh, from Dr.
• 1:15
  Alon: Oz, from CMS on fraud, waste, and abuse in Medicaid and Medicare right now.
• 1:22
  Alon: And I'm, I'm not getting in, in this show in whether it's right or wrong, that's besides the point.
• 1:27
  Alon: But we're just seeing a lot of focus on that area.
• 1:32
  Alon: We're now seeing AI getting deployed to basically understand moving from what they call, "Hey, we used to pay and then we chase you," to now we're auditing first and then paying later.
• 1:44
  Alon: That's a huge mind shift in how money's flowing through Medicaid and Medicare, right?
• 1:51
  Alon: And so I think for these populations- Well, and it's a massive
• 1:53
  John: potential cash flow hit too.
• 1:56
  Alon: Exactly.
• 1:57
  Alon: And remember, these are organizations that already have very thin margins, right?
• 2:02
  Alon: Um, so we're seeing a huge shift, and for these organizations, it's about change.
• 2:11
  Alon: If they don't change now… That's what I'm hearing from CEOs.
• 2:14
  Alon: Their, their mindset is, "If I don't change now, if I don't rethink my workflows and how I operate, it just won't be sustainable."