GAO: Medicaid Databases Don’t Match Up, Leaving Billions Unexplained

According to a report from the Government Accountability Office, Medicaid expenses reported in two different government data sets for fiscal years 2007 through 2009 do not align, leaving billions of dollars in expenditures unexplained.

The two data sets used by the Centers for Medicaid and Medicare Services differ in what information they collect because they’re used for different things.

The Medicaid Statistical Information System (MSIS) provides a summary of expenditures linked to specific beneficiaries on the basis of their medical claims. In contrast, the so-called CMS-64 is designed to reimburse states for their federal share of Medicaid expenditures. It aggregates state spending, but doesn’t include beneficiary-specific data.

Nationally, the differences between the two databases ranged from $43 billion in FY2009 to $46 billion in FY2007. MSIS expenditure amounts were generally less than those reported in CMS-64.

MSIS statistics for Texas for FY2009 show about $18.5 billion in expenditures; CMS-64 shows about $23.7 billion—a difference of roughly $5.2 billion.

The GAO notes that the data could be used to offer a more complete view of the Medicaid program, but the usefulness is limited due to reporting delays for MSIS data and variances between the two sets, both of which are “inconsistent with federal internal control standards,” according to the GAO.

CMS recently completed a pilot study to better integrate MSIS and CMS-64 data. It will begin implementing the program in states as early as 2014, although a specific timeline has not yet been defined.