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Iowa Auditor Slams State Medicaid Program for 'flawed' Data

Iowa Auditor Slams State Medicaid Program for 'flawed' Data
Iowa Auditor Slams State Medicaid Program for 'flawed' Data

DES MOINES, Iowa (AP) — The Iowa Department of Human Services provided data for an audit of its Medicaid Home Health Program that was so flawed that it was unusable, the state auditor said Thursday.

Auditor Rob Sand's report said his staff tried for months to get usable data on the number of patients served, the services received and fees paid. It took eight months to get information from DHS that could be analyzed and even then, the data was useless, Sand said. He said data was missing, incomplete or incorrect.

The Home Health Program provides services including skilled nursing care, physical therapy and health aides for Medicaid recipients in their homes. The audit began in April 2018, before Sand took office in January 2019, and finished 14 months later.

Contracts Iowa signs with the private managed care organizations that are paid to oversee the program say “performance monitoring and data analysis are critical components in assessing how well the contractor is maintaining and improving the quality of care delivered to members.”

“Obviously, you can’t analyze data if the data is not reliable, so if you don’t have good data to analyze you’re going to have a very hard time measuring quality of care as well as stopping fraud,” Sand said.

The state, under Republican Gov. Terry Branstad's direction, took the Medicaid program from state oversight and placed it under the management of private for-profit insurance companies in 2016. He promised the move would save millions of dollars and improve efficiency but since he departed in July 2017 to become U.S. ambassador to China, Gov. Kim Reynolds has put millions more into Medicaid each year amid calls to reverse privatization and restore stability.

Reynolds' spokesman, Pat Garrett, said in a statement that she has made significant improvements to the system.

“All Medicaid data is independently verified by third-party review and an independent actuary,” he said. “The governor commends Iowa DHS employees for an outstanding job providing thorough information to the auditors’ various requests over these last 14 months.”

Critics have said recipient care has suffered under privatization, and hospitals, clinics and other service providers have complained they’re not paid on time and sometimes incorrectly. Two managed care companies have left the state, saying they were losing millions of dollars.

DHS last week temporarily withheld nearly $44 million in payments for this month from Iowa Total Care, one of the state’s managed care companies. Issues cited included unpaid claims, inaccurate claims payments and failure to provide the same type of data that Sand was seeking.

Sand said his audit found there is no efficient or effective manner for DHS to get adequate data from the managed care companies under the current system.

DHS spokesman Matt Highland said the agency disagrees with Sand’s assessment.

“Over these past 14 months, our team was very detailed and meticulous in accommodating the auditor’s requests to best equip their team with a deep understanding of the information they asked for,” he said. “Every day this agency strives to improve communication and transparency to strengthen collaboration and better serve Iowans.”