A review of Medicaid Management Information Systems (MMIS) conducted by the General Accounting Office (GAO) in 10 states showed that while these systems were implemented to detect and prevent improper payments, there was no way to determine their effectiveness.
The report summary noted that all 10 states used MMIS designed primarily for administering Medicaid as a fee-for-service program, but seven states also administered managed care plans in which providers are reimbursed based on a fixed amount each month. One state only administered Medicaid under a managed care plan.
Each state implemented their systems through matching funds from the Centers for Medicare & Medicaid Services (CMS) and relied on technical assistance and provider eligibility information from the agency's database.
But even with help and funding from CMS, this agency does not require states to measure or report quantifiable benefits derived from these systems, the GAO reported. As a result, there is no way to determine how much money is saved or recovered.
The GAO recommends that CMS require states to measure quantifiable benefits. "Such measurement of benefits should reflect a consistent and repeatable approach and should be reported when requesting approval for matching federal funds to support ongoing operation and maintenance of systems that were implemented to support Medicaid program integrity purposes," the GAO said in comments contained in the report.
Read the full report here [PDF]