“The Centers for Medicare & Medicaid Services (CMS) has taken steps to improve Medicaid program integrity and reduce improper payments; however, GAO has identified areas where additional, or continued, action could help strengthen program integrity and ensure beneficiaries’ access to services. These actions include improving data quality, oversight, and federal-state collaboration.”
“Need for better data. As GAO has previously reported, a fundamental challenge to the oversight of the Medicaid program is the lack of complete, accurate, and timely data. This challenge has hindered CMS’s ability to ensure the appropriate use of federal and state dollars for beneficiary care. Without reliable data, CMS is unable to effectively monitor who is providing services, or the type of services provided. CMS has taken steps to develop reliable Medicaid data, most notably with the Transformed Medicaid Statistical Information System, which will collect more information on beneficiaries. This system could improve CMS’s ability to identify improper payments and help ensure beneficiaries’ access to services, but additional work is needed.”
“In December 2017, GAO made two recommendations to CMS to improve the completeness and comparability of the data from this system and CMS’s plans for oversight. The agency concurred with the recommendations, but has not yet implemented them…”
“Manage program risks. From May 2015 to December 2017, GAO made 11 recommendations that could help CMS better assess the risk of fraud, as well as ensure that only eligible providers—particularly those in managed care—and beneficiaries are enrolled and participating in the Medicaid program. The agency generally concurred with these recommendations, but has not yet implemented them…”
“Need for greater federal-state collaboration. GAO has previously reported that collaborative activities between the federal government and the states— such as sharing promising program integrity practices—are important to improving oversight of the Medicaid program…” Read the full document here.
Source: GAO Testimony Before the Subcommittee on Government Operations and the Subcommittee on Intergovernmental Affairs, Committee on Oversight and Government Reform, House of Representative – April 12, 2018. GAO.gov.
