National Medicaid Audit Program: CMS Should Improve Reporting and Focus on Audit Collaboration with States

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A letter report issued by the Government Accountability Office with an abstract that begins "Compared to the initial test audits and the more recent collaborative audits, the majority of the Medicaid Integrity Group’s (MIG) audits conducted under the National Medicaid Audit Program (NMAP) were less effective because they used Medicaid Statistical Information System (MSIS) data. MSIS is an extract of states’ claims data and is missing key elements, such as provider names, that are necessary for auditing. Since fiscal year 2008, 4 percent of the 1,550 MSIS audits identified $7.4 million in potential overpayments, 69 percent did not identify overpayments, ... continued below

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United States. Government Accountability Office. June 14, 2012.

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Description

A letter report issued by the Government Accountability Office with an abstract that begins "Compared to the initial test audits and the more recent collaborative audits, the majority of the Medicaid Integrity Group’s (MIG) audits conducted under the National Medicaid Audit Program (NMAP) were less effective because they used Medicaid Statistical Information System (MSIS) data. MSIS is an extract of states’ claims data and is missing key elements, such as provider names, that are necessary for auditing. Since fiscal year 2008, 4 percent of the 1,550 MSIS audits identified $7.4 million in potential overpayments, 69 percent did not identify overpayments, and the remaining 27 percent were ongoing. In contrast, 26 test audits and 6 collaborative audits—which used states’ more robust Medicaid Management Information System (MMIS) claims data and allowed states to select the audit targets—together identified more than $12 million in potential overpayments. Furthermore, the median amount of the potential overpayment for MSIS audits was relatively small compared to test and collaborative audits."

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Government Accountability Office Reports

The U.S. Government Accountability Office (GAO) is an independent, nonpartisan agency that works for the U.S. Congress investigating how the federal government spends taxpayers' money. Its goal is to increase accountability and improve the performance of the federal government. The Government Accountability Office Reports Collection consists of over 13,000 documents on a variety of topics ranging from fiscal issues to international affairs.

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  • June 14, 2012

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  • June 12, 2014, 7:50 p.m.

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United States. Government Accountability Office. National Medicaid Audit Program: CMS Should Improve Reporting and Focus on Audit Collaboration with States, report, June 14, 2012; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc301262/: accessed September 20, 2018), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.