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Transcript for audio podcast: Transformed Medicaid Statistical Information System

From the Office of Inspector General of Department of Health and Human Services

[Ann Maxwell] I'm Ann Maxwell, Regional Inspector General in Chicago for our Office of Evaluation and Inspections, speaking with Nicole Hrycyk, a team leader from the Chicago office. Let's talk about your recently released evaluation on the Transformed Medicaid Statistical Information System. First, what is this new system?

[Nicole Hrycyk] This new information system is a major upgrade of the only aggregated, national database of Medicaid data. Specifically - eligibility and claims information for the Medicaid program. This upgrade should help protect Medicaid against fraud, waste, and abuse, by using national data to improve oversight.

[Ann Maxwell] Nicole, why is there a need to transform the current Medicaid data?

[Nicole Hrycyk] Previous OIG work found that the current national Medicaid database is not complete, accurate, or timely. Specifically, it doesn't have all of the data that is needed to conduct national Medicaid program integrity activities. Missing data include elements like patient name and address or specific billing information. Without all the necessary data, it's hard to identify Medicaid overpayments.

[Ann Maxwell] Is that why it's important to have good quality, national Medicaid data?

[Nicole Hrycyk] Yes. With quality national data, the Federal Government can support States' program integrity efforts by monitoring fraud that crosses State lines. I want to emphasize that each State keeps its own Medicaid data, so States can conduct their own program integrity activities. But having accurate national data helps highlight trends, and helps compare Medicaid integrity issues across States.

[Ann Maxwell] What prompted this evaluation of the national Medicaid data?

[Nicole Hrycyk] Actually, Congress wanted an update on the status of this new information system, and if the new data would be any better than the current data.

[Ann Maxwell] And what did you find?

[Nicole Hrycyk] Although the new system is still in the early stages, we found limited progress. Our work also raised questions about the completeness and accuracy of the data when the new system is fully implemented.

[Ann Maxwell] What do you mean by limited progress?

[Nicole Hrycyk] As of January 2013, 12 States were working with the Centers for Medicare & Medicaid Services, or CMS, to implement this new information system but the other States hadn't started.

[Ann Maxwell] What progress did the 12 States make?

[Nicole Hrycyk] They made some progress. CMS created a set of 23 milestones to guide States on implementing the new system. We conducted our review about 6 months in to implementation and all of the 12 States made progress in the planning stage, like getting State approval and developing a schedule. They made less progress in the other stages, including design, development, and testing.

[Ann Maxwell] But, most States hadn't started as of January 2013, correct?

[Nicole Hrycyk] Correct. Seventeen States told CMS that they planned to begin implementing in 2013. The other 22 States did not say when they would begin.

[Ann Maxwell] So, when does CMS expect this new national Medicaid data to be available?

[Nicole Hrycyk] CMS set a deadline for when States should submit data, but that doesn't mean that the data will be complete, accurate, and able to be used for national program integrity oversight.

[Ann Maxwell] Why not? How could this new system be fully implemented and the data not be ready to use?

[Nicole Hrycyk] Well, we found that the 12 States indicated that their data systems didn't have all of the data elements. And, CMS and the 12 States reported some concerns about the accuracy of the data. Until the data that States submit are complete and accurate - the data may have limited use for program integrity purposes.

[Ann Maxwell] Wow. These are pretty important concerns. What did you recommend?

[Nicole Hrycyk] We recommended that CMS set a deadline for when national data will be available - not just a deadline for States to implement the process of transmitting the data. Also, we recommended that CMS ensure that States submit all of the required data, and that the data are complete, accurate, and timely.

[Ann Maxwell] And how did CMS respond to your recommendations?

[Nicole Hrycyk] CMS agreed, and has already taken some steps by issuing a letter to all State Medicaid Directors. This letter stated that all States are expected to submit data by July 1, 2014 but didn't address when the data will be complete and accurate. And that is the key deadline that OIG recommended.

[Ann Maxwell] Thank you, Nicole, for sharing this important work on Medicaid data and Medicaid program integrity.

[Nicole Hrycyk] Thank you, Ann.


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