Key CMS database unresponsive, inadequate

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The Department of Health and Human Services’ Office of Inspector General released a memo (27-page PDF) detailing an investigation that found that the effectiveness of a key database used for detecting Medicaid fraud has been compromised by slow response times and inefficient data tracking.

The Centers for Medicare and Medicaid Services’ Medicaid Statistical Information System is “the only nationwide Medicaid eligibility and claims information source.” It aggregates Medicaid from states, and its data are relied upon by a number of other federal databases and agencies. MSIS is used as a source on everything from data releases to congressional inquiries.

And, as is most relevant to the OIG’s investigation, MSIS is used by Medicaid Integrity Program to detect fraud, waste and abuse in the system. In the course of the investigation, OIG agents evaluated MSIS for immediacy, accuracy and utility. Investigators found that, between 2004 and 2006, eligibility and claims files both took almost 600 days to complete their file submission and validation process, and that “states submitted nearly two-thirds of the initial MSIS file submissions after the CMS due dates.” Furthermore, 32 states didn’t even get their submissions in within six months of the deadline.

Investigators also faulted CMS for not reporting adjustments that would affect statistical error in the data and for not tracking categories that would be useful in detecting fraud.

(Hat tip to Peter Newbatt Smith of The Center for Public Integrity)

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