Medicaid's Quality Control System is not Realizing Its Full Potential.
Abstract
Medicaid's quality control program (which includes analyses of a sample of cases) identifies problems which result in erroneous payments and devises methods for overcoming these problems. Potentially severe penalties against States exceeding target error rates have been tied to the program, resulting in quality control focusing on data collection instead of corrective action. GAO recommends that the Congress establish a balanced system of less severe penalties for poor State performance and rewards for good performance. This would redirect the program toward making sure that problems are corrected. In turn, future erroneous payments would be minimized. Many inaccuracies and weaknesses in sample cases cast doubt ont he validity of quality control findings. Therefore, GAO believes the error rates developed by quality control are not adequate bases for assessing penalties. GAO also recommends to the Secretary of Health and Human Services several modifications to quality control processes which would provide more useful information for corrective action purposes. (Author)
Document Details
- Document Type
- Technical Report
- Publication Date
- Oct 23, 1981
- Accession Number
- ADA108437
Entities
Organizations
- United States Government Accountability Office