Dive Brief:
- An audit from the HHS office of Inspector General has concluded that a federal information sharing system operated by CMS to prevent fraudulent Medicaid billing isn't working as intended.
- As required by the ACA, the Medicaid And Children's Health Insurance Program State Information Sharing System was created in 2011. Under the program state Medicaid administrators must report to the database providers who have been "terminated" from billing Medicaid because they were convicted of major crimes, lost their medical licenses or were otherwise disciplined.
- However, the OIG audit found that 17 states and the District of Columbia have not provided databases any information on providers banned from billing their Medicaid programs. Meanwhile, those states that did submit data did not do so correctly in many cases.
Dive Insight:
With just four states reporting the bulk of the data (California, Illinois, New York and Pennsylvania), and the data they have submitted riddled with errors, this program seems to be on life support at best. CMS will have to push hard to make something of this mess.