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GAO: CMS Implemented 3 of 11 Recommendations on Medicaid Program Integrity

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The Centers for Medicare and Medicaid Services has implemented only three of 11 recommendations that the Government Accountability Office made to help address program integrity challenges related to Medicaid.

GAO said Tuesday CMS developed an approach to verify if an individual is qualified to enroll into into the joint federal-state healthcare program but the government watchdog noted gaps remain in measures to confirm eligibility.

Auditors found CMS has yet to ensure that the federal government appropriately matches Medicaid expenditures for enrollees, especially for individuals that gained eligibility through the expansion of the Patient Protection and Affordable Care Act.

GAO added the agency also gave additional guidance to states on the oversight of Medicaid managed care and current resgulations direct all managed care providers to enroll with the state Medicaid agency in an effort to boost oversight of such providers.

A GAO study based on two states and 16 health plans identified challenges in the screening of providers for eligibility.

CMS implemented policies and procedures to prevent duplicate Medicaid and subsidized coverage but the agency has yet to develop a plan to assess whether those procedures sufficiently mitigate and detect duplicate coverage, according to GAO.

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