GAO contends oversight is lacking for national repository of Medicaid data

Watchdog agency estimates $36.7B in payment errors last year despite implementation of the Transformed Medicaid Statistical Information System.

While nearly all states are now reporting to a national repository for Medicaid data, the data are not sufficient to provide effective oversight of the program, according to a new audit by the Government Accountability Office.

Data from the Transformed Medicaid Statistical Information System (T-MSIS) was meant to enhance the ability of federal administrators to identify potential fraud while improving program efficiency. However, GAO auditors report that despite the fact that 49 states had begun reporting T-MSIS data as of this past November, an estimated $36.7 billion in payment errors were still made in 2017.

Although 49 states reporting data to T-MSIS is a significant increase from the 18 states that were doing so in October 2016, concerns persist over the completeness and comparability of state data, according to GAO.

“The Centers for Medicare and Medicaid Services has taken an important step toward developing a reliable national repository for Medicaid data. However, data challenges have hindered states’ and CMS’s use of the T-MSIS data for oversight,” find the auditors.

Also See: Medicaid data not yet available for system, oversight

Although CMS has taken steps to begin using T-MSIS data, GAO contends that the agency has not yet fully articulated a plan for how and when it will use T-MSIS data for its own broader oversight efforts of state Medicaid programs. “As a result, important CMS goals for T-MSIS, such as reducing states’ reporting burden and enhancing program integrity activities, are not being fully realized.”

Auditors in their report recommended that CMS improve T-MSIS's completeness and comparability to expedite its use, and articulate a specific oversight plan.

CMS officials were not immediately available to respond. However, in written comments to the GAO report the Department of Health and Human Services concurred with auditors’ recommendations.

According to HHS, it has taken several actions to improve the quality of T-MSIS data, including developing a database on data quality findings, which could be used to identify solutions for common problems across states, as well as developing a data quality scorecard for TMSIS users that aggregates data quality findings in a user-friendly tool.

In addition, HHS noted in its written comments to the report that stated that it will continue to work to obtain complete T-MSIS information from all states; take additional steps to share information across states on T-MSIS data limitations; and implement ways for states to collaborate regarding T-MSIS.

Further, the agency indicated it is in the process of developing a plan for using T-MSIS data for Medicaid program oversight.

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