GAO reports assail Medicaid oversight, provider vetting

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GAO: CMS should tighten oversight of payments.
GAO: CMS should tighten oversight of payments.

The Government Accountability Office recently issued a pair of reports within days of one another critical of how the Medicaid program gathers data and screens its provider participants.

Medicaid, by far, is the leading source of payment for long-term care services in the U.S.

Inaccurate, incomplete and often tardy data hampers program oversight, the GAO found in a report issued Feb. 6 

The government watchdog questioned methods used by the Centers for Medicare & Medicaid Services to calculate funding for states and beneficiary claim reviews. Under scrutiny were the CMS-64, a system used to calculate matching Medicaid funds for states, and the Medicaid Statistical Information System, or MSIS, which reports on individual beneficiary claims.

Beneficiary utilization data, particularly related to Medicaid managed care, can be a key tool to identify “inappropriate” provider behavior, they added, noting it unfortunately often is incomplete and reported up to three years late. 

Report authors recommended CMS take “immediate” action to improve the data used for Medicaid oversight. 

Another recent GAO report announced that gaps still remain in ensuring that providers that apply to the Medicaid program are properly vetted.  

In “CMS Has Taken Steps, but Further Efforts Are Needed to Control Improper Payments,” GAO authors noted that the Medicaid program's size and diversity make it “particularly vulnerable to improper payments.”

Investigators made several new recommendations on how CMS could tighten oversight, including creating a plan to make sure Medicaid and other coverages don't overlap. GAO also reminded CMS that it had not acted on several of its earlier recommendations.