GAO Diagnoses State/CMS Data Malady–Flags $36.7 Billion Improper Payments

The Trump administration has a fever for curing Fraud, Waste, and Abuse (FWA)–in fact, this is perhaps the most important Three Letter Acronym in Federal IT today. So, GAO’s January report on the shortcomings of CMS Transformed Medicaid Statistical Information System (T-MSIS) and the fact that Medicaid improper payments hit an estimated $36.7 billion in 2017 raised temperatures across government.

So, what is T-MSIS and why is GAO getting hot under the collar? CMS developed T-MSIS in 2011 to modernize the way that states report Medicaid data to CMS. The system provides common data standards to reduce the reporting burden on states and normalize information feeds so that CMS can effectively analyze data to detect best practices and anomalies.

That makes a lot of sense. However, GAO tells us the program still isn’t doing that effectively.

While 49 states reported their data to T-MSIS in 2017–a significant jump from just 18 in 2016–data quality issues persist. States collect diverse data and fit it into T-MSIS data categories in different ways, which makes comparisons difficult. On top of that, some states are still not reporting current data.

CMS already took some steps toward a cure, setting up data standards to help and monitoring data with 2,800 automated quality checks. But regrettably, according to GAO, it still lacks a broader plan.

Here’s GAO’s prescription. First, CMS needs to improve data standards to make T-MSIS usable. Further, the agency must come up with a “specific plan and time frames for how to use the data for oversight,” the report said.

CMS acknowledged GAO’s recommended regimen with three ways that it intends to improve. These include efforts to make its data more complete, share more information on data limitations, and set up ways for states to collaborate on the data. But it also noted that it depends on the states for its data quality, and cannot fix all quality issues.

As Dr. Donald looks to amputate–agencies need to keep all their IT limbs in good working order.

Recent