ARTICLE
17 March 2015

GAO Seeks Stronger CMS Measurement Of State Medicaid Program Integrity System Effectiveness

Based on a review of 10 state Medicaid Management Information Systems used to process claims and support program integrity efforts, the GAO has concluded that the effectiveness of these systems is not known.
United States Food, Drugs, Healthcare, Life Sciences

Based on a review of 10 state Medicaid Management Information Systems (MMIS) used to process claims and support program integrity efforts, the GAO has concluded that the effectiveness of these systems is not known because CMS does not require states to measure results related to detecting and preventing improper payments. The GAO therefore recommends that CMS require states to measure and report quantifiable benefits of program integrity systems when requesting federal funds; CMS agreed.

This article is presented for informational purposes only and is not intended to constitute legal advice.

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