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Medicaid: Use of Claims Data for Analysis of Provider Payment Rates

GAO-14-56R Published: Jan 06, 2014. Publicly Released: Jan 06, 2014.
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What GAO Found

Why GAO This Study

GAO prepared this report under the authority of the Comptroller General to conduct work on GAO's initiative to assist Congress with its oversight responsibilities for the Medicaid program. In this report, GAO provides information on: (1) the extent to which state Medicaid programs vary the rates paid to providers for a given service and the basis for the variation; and (2) the extent to which Medicaid provider payment rates calculated from claims data confirm rates reported in studies of states' fee schedules.


GAO makes no recommendations in this report. The Department of Health and Human Services reviewed a draft of this report and provided technical comments, which GAO incorporated as appropriate.

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Comparative analysisMedicaidDentistsFee-for-service plansHealth care programsPatient care servicesPaymentsPediatricsPhysiciansQuality of careMedical services ratesMedical expense claimsSurveys