Auditor decries 'bad data' from Iowa's Medicaid program

Jan. 9--DES MOINES -- State Auditor Rob Sand said Thursday his office's efforts to track home health care services provided under the state's privatized Medicaid system were stifled by "bad data," inefficiencies and slow response times that should be of concern to taxpayers and addressed by Gov. Kim Reynolds and her Iowa Department of Human Services administrators.

"Obviously, you can't analyze data if data is not reliable. And so if you don't have good data analysis, then you're going to have a very hard time measuring quality of care as well as stopping fraud," Sand, a Democrat who has been state auditor for a year, told a news conference.

He said, in releasing a 13-page report, his office encountered resistance from Iowa Medicaid managers in gathering the information.

"Long story short, the finding in this audit is we do not have reliable data. Data are missing. Data are incomplete and incorrect," he said.

Sand said his office set out to conduct "an encounter data" review to assess the quality of home health services that stretched back to May 2018. But the focus shifted to a frustrating series of attempts to amass information that included a "game of telephone" with Iowa Medicaid Enterprise administrators and providers that left auditors unable to perform their role as watchdogs of taxpayer resources, Sand said.

"Our finding at the end of the day with this matter is essentially we were -- despite repeated efforts -- unable to perform an analysis and audit of home-health data because the data provided were repeatedly unreliable," he told reporters.

"Me, as a taxpayer, I want to know what's happening with my money. We are standing here today telling you that due to the quality of the data that we were repeatedly provided by DHS, we can't answer that question. I think that's pretty concerning."

Since his office is charged with powers to investigate, report and make recommendations but not to "force changes upon the system," Sand said it is up to the governor and the Legislature to make certain that contract provisions with private managed-care organizations are enforced -- which includes having reliable data.

In 2016, then-Gov. Terry Branstad, a Republican, shifted from a state-run fee-for-service Medicaid program to a system managed by private insurance companies that contract with the state for capitation payments to oversee enrollees and service providers. More than 600,000 Iowans are enrolled in the program.

The privatized system has been a flashpoint between Democrats and Republicans. Current GOP Gov. Kim Reynolds strongly supports the shift, saying that problems with its rollout are being addressed.

"At the end of the day, what we're doing with this program starts and stops in the governor's office," Sand said. "At the end of the day, good or bad, the program depends on the governor taking action to assess problems and to address problems."

Human Services officials released a statement in response to Sand's report saying the agency's staff was "very detailed and meticulous in accommodating" requests from the auditor's office for data over the past 14 months and is striving to improve communication, transparency and collaboration.

"DHS relies on thorough third-party validation with independent actuarial reviews for all Medicaid data to ensure we're good stewards of the resources entrusted to us by taxpayers and the state of Iowa," according to the statement. "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."

Likewise, Reynolds' spokesman Pat Garrett responded in a statement indicating the governor "has made significant improvements to Iowa's managed care system to better serve Iowans. All Medicaid data is independently verified by third party review and an independent actuary, and the governor commends Iowa DHS employees for an outstanding job providing thorough information to the auditors' various requests over these last 14 months."

However, Sand used a sports analogy to describe his fact-finding sojourns, telling reporters "if this were baseball and we were calling a very tight, conservative strike zone, DHS struck out and we continued to pitch. Four strikes overall on DHS' part in terms of trying to pull reliable data from which we could actually perform and analysis and draw conclusions."

The state auditor said his office has authority to use subpoena power to require agencies to produce requested information but he ruled that out because data was produced -- but often insufficient, unreliable and incomplete.

"We were probably more patient in this audit than we will be in future audits," said Sand, noting his office has "multiple audits open" on other parts of Medicaid.

Sand said he has not discussed his findings with Reynolds but would welcome such a meeting.

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