About 70 percent of Medicaid beneficiaries receive managed care services. In 2009, OIG found managed care encounter data incomplete. This study — which examines third quarter fiscal year 2011 files for the 38 states with managed care programs that require reporting — found reporting to be slightly improved since 2009, but far from perfect.
The study found eight of the 38 states did not report any encounter data. For six of these states, CMS knowingly accepted claims files without encounter data and the remaining two submitted the data nearly two years after the deadline, according to OIG.
An additional 11 states did not fully report data for all managed care services in the state. Four were unable to collect the data, two were unable to report the data due to technological limitations and one state reported both issues. The remaining states did give a reason for the incomplete data, according to the report.
Seven other states submitted invalid, blank, “dummy” or multiple data points, resulting in OIG being unable to draw conclusions on the encounter data from these states.
In light of these findings, OIG recommended CMS withhold funds from states that fail to comply with data submission requirements and monitor the data submitted.
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