This report provides information about the Medicaid Statistical Information System (MSIS) data from fiscal years (FY) 2004 to 2006. Specifically, it provides information on: (1) the length of time that the States and the Centers for Medicare & Medicaid Services (CMS) took to submit and release the MSIS data; (2) CMS disclosure and documentation of the accuracy of MSIS data; and(3) the extent to which the MSIS captured information for detecting fraud, waste, and abuse.

We found that, on average, FYs 2004-2006 MSIS data took an average of over 1 and a half years after the initial State data submission before CMS released them to the public. This time frame included an average of 6 months that States took to submit the MSIS fies in a CMS-acceptable format and averages of 4 and 9 months for CMS to validate and release the files to the public,respectively. In addition, CMS did not fully disclose or document information about the accuracy of the MSIS data. Finally, as of June 2009, the MSIS had not captured many data elements that can assist in fraud, waste, and abuse detection. 

Timely, accurate, and comprehensive MSIS data can be used to meet the Health Care Fraud Prevention and Enforcement Action Team (HEAT) objectives. In May 2009, HHS and the Department of Justice established HEAT as an inter-agency effort to combat health care fraud. HEAT includes a focus on expanding data usage to more effectively identify and prevent Medicaid fraud. 

Full Report: Memorandum Report: MSIS Data Usefulness for Detecting Fraud, Waste, and Abuse (PDF | 387.55 KB)

HHS Office of the Inspector General. (2009). Memorandum report: MSIS data usefulness for detecting fraud, waste, and abuse. OEI 04-07-00240. Wright, Stuart.