Using T-MSIS and TAF to Elevate Medicaid Program Integrity

Federal and state officials, including members of Medicaid program integrity teams, Medicaid fraud units, and offices of state attorneys general, are seeking robust tools to detect and prevent fraud, waste, abuse, and improper payments, and to provide services to enrollees as cost effectively as possible.

The Transformed Medicaid Statistical Information System (T-MSIS) and T-MSIS Analytic Files (TAF) provide an opportunity to improve data access for states, which is one of the most critical needs in advancing fraud and waste initiatives.

These data assets are worth considering for state program integrity units, not only because their national scale lends them to answering the kinds of questions that can be difficult for state-specific data sources to address, but also because T-MSIS is used by CMS’s Center for Program Integrity, which is charged with detecting fraud, waste, and abuse.

In this white paper, we explore how states can tap into the T-MSIS data set—the most complete set of Medicaid data available—to strengthen oversight, uncover patterns, and enhance the impact of program integrity efforts.