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Diane Publishing Books
Medicaid: Data Sets Provide Inconsistent Picture of Expenditures
Carolyn L. Yocom (au)
The Centers for Medicare & Medicaid (CMS), within the Dept. of Health and Human Services (HHS), and state Medicaid agencies jointly administer the multibillion-dollar Medicaid program, which finances health care for certain low-income individuals. Medicaid is on GAOäó»s high-risk list because of vulnerabilities to waste, fraud, abuse, and mismanagement. CMS has two data sets that report state Medicaid expenditures. The MSIS data set is designed to report individual beneficiary claims data. The CMS-64 data set aggregates statesäó» expenditures, which are used to reimburse the states for their Medicaid expenditures. However, neither data set provides a complete picture of Medicaid expenditures. This report (1) examines the extent to which MSIS and CMS-64 expenditure data differ and (2) where possible, quantifies the identified differences between the two data sets. It reviewed documents, compared Medicaid expenditure data, and interviewed CMS and state officials. This report used FY 2007 through 2009 data äóî the most-recent and most-complete data available. Tables and figures. This is a print on demand report.
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