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Integrity of Medicare Advantage Encounter Data

In 2012, Centers for Medicare & Medicaid Services began collecting from Medicare Advantage organizations a more comprehensive set of encounter data reflecting the items and services provided to Medicare Advantage plan enrollees. Previous Centers for Medicare & Medicaid Services and OIG audits have indicated vulnerabilities in the accuracy of data reported by Medicare Advantage organizations. Realizing the potential benefits of the Medicare Advantage encounter data for payment and program integrity oversight is contingent upon the data�s completeness, validity, and timeliness. We will review Centers for Medicare & Medicaid Services's oversight of Medicare Advantage encounter data validation and assess the extent to which Centers for Medicare & Medicaid Services's Integrated Data Repository contains timely, valid, and complete Medicare Advantage encounter data.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
October 2017 Centers for Medicare & Medicaid Services Integrity of Medicare Advantage Encounter Data Office of Evaluation and Inspections OEI-03-15-00060 2018

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201