GAO: Medicaid payment records incomplete

On the heels of a report earlier this month that as many as 1,800 physicians continued billing state Medicaid programs after they were banned from Medicare, a new report released by the Government Accountability Office (GAO) indicates that Medicaid payment records are inaccurate and incomplete.

The GAO reviewed payment data from three states--Illinois, New York, and California--and concluded that Centers for Medicare & Medicaid Services (CMS) oversight is "limited in part by insufficient information on payments and also by the lack of a policy and process for assessing payments to individual providers." In fact, California payment data to individual hospitals was so poor that the GAO could not conduct an accurate evaluation.

Data from Illinois and New York showed that a number of hospitals received Medicaid payments that exceeded the cost of service. In Illinois, six of the seven hospitals that had high daily payments also received payments that exceeded costs. In New York, the GAO identified nine hospitals that received high daily Medicaid payments, four of which exceeded costs. However, two of those hospitals, which were owned by the local government, received nearly $400 million more than the cost of service.

The GAO recommended CMS "ensure states report provider-service payment data, establish a criteria for assessing payments to individual providers, develop a process to identify and review payments to individual providers, and expedite its review of the appropriateness of New York's hospital payments"--all of which the Department of Health and Human Services agreed with.

Last year, the GAO criticized Medicaid for varying payments for identical services in states throughout the country. Earlier this month, FierceHealthPayer: AntiFraud reported that unwieldy payment data continues to plague CMS, opening up avenues for fraud, waste and abuse.

For more:
- here's the GAO report

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