A key Centers for Medicare and Medicaid Services database that’s the only place to find data on Medicaid claims and eligibility data is woefully inadequate, according to a report (PDF) by the Dept. of Health and Human Services inspector general’s office.
The Medicaid Statistical Information System is “the only nationwide Medicaid eligibility and claims information source,” a collection of data from states used by federal agencies — including the $100 million Medicaid Integrity Program in its battle against fraud, waste and abuse.
But an investigation of data filed between 2004 and 2006 found that it took an average of a year and a half for the agency to evaluate and release the data after submission.
That’s due to a daisy chain of delays: States took more than six months to submit files in a CMS-acceptable format, CMS took more than four months to validate the data and an additional nine months to release the files to the public.
That’s just for the 54 percent of completed files for the period. The remaining 46 percent of the MSIS files were in various stages in the process — and 10 percent of those hadn’teven been received from the states yet.
And two-thirds of the initial filings from the states were late; all but two states filed late at least once and 32 states missed the deadlines for 31 percent of their filings by six months.
As for CMS, the agency failed to disclose or document individual states’ adjustments to the error tolerances in the data, meaning that the data was less accurate than the agency publicly disclosed it to be.
Perhaps the most serious lapse was the failure to capture data CMS itself tagged as valuable in its fight against fraud and abuse. The database missed nearly half of those data, including information on service providers, procedure, product and service descriptions, billing information and beneficiary and eligibility data.