HHS Calls on CMS to Reevaluate Medicare-Medicaid Data Matching ProgramImage Banner

HHS Calls on CMS to Reevaluate Medicare-Medicaid Data Matching Program

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HHS Calls on CMS to Reevaluate Medicare-Medicaid Data Matching Program

April 26, 2012

On April 24, the U.S. Department of Health & Human Services' Office of Inspector General (OIG) released a report, suggesting that the Medicare-Medicaid (Medi-Medi) data match initiative needs to be completely overhauled.


The Medi-Medi data matching program was designed to identify aberrant billing patterns between the two programs and thereby identify and reduce fraud and waste. From 2007 to 2008, the program cost $60 million, but only recouped or prevented $57.8 million in wrongful payments. The program also referred 66 cases to law enforcement, of which slightly more than a third were accepted for prosecution.


Because the cost of the program currently exceeds its returns, the OIG recommends that the Centers for Medicaid & Medicare Services reevaluate the goals, structure and operations of the Medi-Medi program to determine any aspects that should be retained as part of CMS' overall program integrity strategy.