Medicaid Center Lacks Proper Data on Funding and Claims, GAO Says

(Photo: CMS.gov)

The Centers for Medicare and Medicaid Services do not have enough medical data to ensure that payments are correct or beneficiaries have access to covered services, according to a Government Accountability Office report released Feb. 6.

CMS, which presides over the Medicaid program, uses two data sources. One data source, CMS-64, is used to calculate Federal matching funds for states. The other source, the Medicaid Statistical Information System (MSIS), is used to report individual beneficiary claims data. Both CMS-64 and MSIS provide Medicaid administrators with records of payment and overall spending. However, GAO found that CMS use of this data is hamstrung because of “issues with completeness, accuracy, and timeliness.”

GAO found that expenditure data lacked sufficient information on how states finance Medicaid costs, “complicating CMS’s ability to assess the appropriateness of states’ financing.” The report also says that MSIS data is often incomplete and is sometimes reported up to three years late, hindering CMS’s ability to track billing patterns and make sure beneficiaries have access to covered services.

This report is not the first time CMS has been notified about issues with its Medicaid data. According to the report, $36 billion in improper payments occurred in fiscal year 2016. CMS launched its Transformed Medicaid Statistical Information System (T-MSIS) in 2014 as an attempt to improve Medicaid data and program oversight.

However, T-MSIS has had a slow start, GAO reports. As of October 2016, 18 states were submitting T-MSIS data. CMS officials reported that several factors contribute to the stalled progress, including 30 states’ efforts to redesign or replace their Medicaid information technology systems.

“CMS’s continued reliance on inaccurate, incomplete, and untimely data, and the ongoing uncertainty about the scope and timing of its remedial actions, hamper effective oversight and are inconsistent with Federal internal control standards, which require entities to rely on quality and timely information to oversee their programs and take timely actions to improve deficiencies,” the GAO report says.

GAO recommended that CMS immediately improve the quality of Medicaid data available for program oversight. HHS concurred with GAO’s recommendation.

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