Improper payments, bad data threaten access to long-term care, GAO health leader testifies

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“The Medicaid program alone accounted for 26.1 percent of the fiscal year 2017 government-wide improper payment estimate,” Carolyn L. Yocom testified
“The Medicaid program alone accounted for 26.1 percent of the fiscal year 2017 government-wide improper payment estimate,” Carolyn L. Yocom testified

Despite efforts to reduce improper payments in Medicaid, they continue to increase — rising to about $37 billion in fiscal year 2017,  the Government Accountability Office's healthcare director told members of Congress Thursday.

“The Medicaid program alone accounted for 26.1 percent of the fiscal year 2017 government-wide improper payment estimate,” Carolyn L. Yocom testified before the House subcommittees on Government Operations and Intergovernmental Affairs. “It is critical to take appropriate measures to reduce improper payments, as dollars wasted detract from our ability to ensure that the individuals who rely on the Medicaid program — including children, and individuals who are elderly or disabled — are provided adequate care.”

Yocum's testimony focused on the need for better data collection, improved oversight and greater federal-state collaboration to safeguard the Medicaid program. Yocum drew on previous GAO reports issued since May 2015.

She said Medicaid expenditure data does not provide CMS with enough information to consistently ensure payments are proper because it does not include eligibility type. GAO also has previously found utilization data tracking covered healthcare services is incomplete and reported late.

For example, in January 2017, GAO found that the most recent Medicaid personal care services data was from 2012, and only 35 states had finished reporting it.

The testimony also outlined multiple GAO recommendations that have gone ignored or only partially addressed by CMS. Among those identified by Yocum was a 2017 call for improved oversight of payment rates for long-term services and supports provided through Medicaid Managed Care.

GAO recommended CMS require all states to collect and report on progress toward achieving managed long-term scare goals, such as whether the program enhances the provision of community-based care; establish criteria for situations warranting exceptions to  federal rate standards; and provide states with guidance that includes minimum standards for data validation procedures.

That and several other recommendations remain unimplemented as of March, Yocum reported.

Her testimony came as conservatives —including some inf donors this week launched a new campaign targeting the deficit, ramping up conversation about trimming entitlements.

“Beneficiaries who have limited ability to care for themselves rely on long-term services and supports, including nursing home care and home- and community-based services,” Yocum said in her prepared comments. “Oversight to ensure access and the quality of these services is particularly critical given that Medicaid is the largest payer of services for both of these groups.”