The State Auditor’s office says it cannot determine whether home health care claims are being paid properly under Iowa’s privatized Medicaid system because data provided by the Department of Human Services is inaccurate and inconsistent.
State Auditor Rob Sand said his office requested information about home health services provided from April 2016, when the state initiated its privatized Medicaid system, though the end of 2018. Staff members worked for eight months to receive the data, and when it arrived they found problems with dual entries and care providers put into the wrong categories.
“If we can’t assess the quality of the care because the data are not reliable, that certainly calls into question the quality of that care,” Sand said.
The state’s contract with the managed care organizations (MCOs) that operate the state’s Medicaid system requires that data are provided that can be used to determine the quality of care. The auditor’s report says DHS should enforce the contract and require more useful numbers.
“We signed a contract and we should use the contract we signed to get the quality of care, the access to care and the cost of care that we were promised when we signed the contract,” Sand said.
DHS director Kelly Garcia said her agency tried to provide the information the auditor’s office needed and to explain the data that was shared, but she said claims often have initial errors.
“The data points take a long time for us to see as well, because providers have a long amount of time to cure issues on their end and ensure the data sets are complete,” Garcia said. “It takes a while to ensure the data is accurate and that’s not an issue on the agency’s part. That is true of insurance product lines in general.”
Garcia, who said she has not met Sand since taking the top job at DHS in November, said it can take months to correct mistakes. In a statement, DHS also said that Medicaid data go through a third-party verification process.
Last week, DHS announced it is withholding a $44 million payment to Iowa Total Care, one of two MCOs under contract with the state, in part because of inaccurate data submissions. Garcia said those errors are unrelated to the State Auditor’s report.