The Centers for Medicare and Medicaid Services have undertaken a number of steps to improve Medicaid financial management, including efforts to oversee state claims for federal reimbursement and to identify payment errors, but it needs to sustain efforts to improve oversight, the Government Accountability Office has said.
It said CMS increased its ability to address high-risk state funding practices that inappropriately increase federal costs by hiring about 90 funding specialists, that it has created a new unit that centralized responsibility for approving state plan amendments related to reimbursement, and that the agency continued to identify billions of dollars in questionable federal reimbursement through focused financial reviews.
The agency also set goals to reduce questionable federal reimbursement and to hold financial managers accountable, and it also beefed up its process to track the results of its financial management activities, according to GAO-06-705.
It said however that CMS has not instituted mechanisms to measure how the risk of inappropriate federal reimbursement has changed as a result of corrective actions taken — nor has it incorporated the use of the Medicaid Statistical Information System database into its oversight of states’ claims or other systems projects intended to improve its analysis capabilities.
GAO also said CMS has yet to develop profiles to document information on state fraud and abuse controls to use in its oversight of state claims, and that CMS has not developed a strategic plan specific to its Medicaid financial management activities.
Medicaid covered over 56 million people at a cost of $295 billion in fiscal year 2004.
