OIG says Medicare race knowledge is inaccurate and hinders well being disparities assessments


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There are important inaccuracies in Medicare knowledge on race and ethnicity, which is particularly troublesome on condition that the Facilities for Medicare and Medicaid Companies is seeking to gather such knowledge from suppliers and payers, in keeping with the Division of Well being and Human Companies’ Workplace of the Inspector Normal.

Medicare’s enrollment race and ethnicity knowledge are much less correct for some teams, notably for beneficiaries recognized as American Indian/Alaska Native, Asian/Pacific Islander or Hispanic, the OIG discovered.

This inaccurate knowledge, the federal company claimed, limits the power to evaluate well being disparities. Restricted race and ethnicity classes and lacking info contribute to inaccuracies within the enrollment knowledge.

Though the usage of an algorithm improves the prevailing knowledge to some extent, it falls in need of self-reported knowledge, OIG stated. And Medicare’s enrollment knowledge on race and ethnicity are inconsistent with federal knowledge assortment requirements, which inhibits the work of figuring out and enhancing well being disparities inside the Medicare inhabitants.


The disparate impacts of the COVID-19 pandemic on varied racial and ethnic teams have introduced well being disparities to the forefront, spurring the OIG to conduct the research. Folks of coloration have been discovered to expertise disparities in areas akin to entry and care high quality, which may have important unfavorable implications for his or her well being.

CMS has made advancing well being fairness a prime precedence underneath the Biden Administration, and a part of that objective includes guaranteeing that Medicare is ready to assess disparities – which hinges on the standard of the underlying race and ethnicity knowledge.

OIG analyzed the race and ethnicity knowledge in Medicare’s enrollment database, the one supply of the data for enrolled beneficiaries. That knowledge in flip is derived from supply knowledge from the Social Safety Administration and the outcomes of an algorithm that CMS applies to the supply knowledge.

The company assessed the accuracy of Medicare’s enrollment race and ethnicity knowledge for various teams by evaluating them to self-reported knowledge for a subset of beneficiaries who reside in nursing houses. Race and ethnicity knowledge that’s self-reported is taken into account probably the most correct.

OIG additionally assessed the adequacy of Medicare’s knowledge utilizing the Federal requirements for gathering race and ethnicity knowledge as a benchmark.


A number of suggestions had been issued within the report. For one, OIG stated that CMS ought to enhance its race and ethnicity knowledge – a major enterprise, but additionally a urgent want.

To that finish, OIG advisable that CMS:

  • develop its personal supply of race and ethnicity knowledge.
  • use self-reported race and ethnicity info to enhance knowledge for present beneficiaries.
  • develop a course of to make sure that the info is as standardized as attainable.
  • educate beneficiaries about CMS’s efforts to enhance race and ethnicity info.

CMS didn’t explicitly concur with the primary advice, however concurred with the opposite three suggestions.

Twitter: @JELagasse
Electronic mail the author: jeff.lagasse@himssmedia.com

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