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Medicaid Managed Care: Additional CMS Actions Needed to Help Ensure Data Reliability

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Report Type Reports and Testimonies
Report Date Oct. 19, 2018
Release Date Nov. 19, 2018
Report No. GAO-19-10
Summary:

States collect data on Medicaid services to help the Centers for Medicare & Medicaid Services (CMS) oversee the managed care program. For example, this data can help set managed care payment rates, identify inappropriate billing patterns, and ensure access to services.

But what if the data isn’t reliable?

CMS started requiring states to have independent audits of their data to help ensure reliability, but hasn't fully informed states on how to conduct these audits—which could lead to inconsistent results.

We recommended that CMS give states more information on the audits and how it will enforce the new data reliability requirements.

 

Photo of a stethoscope on a computer keyboard.

Photo of a stethoscope on a computer keyboard.

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