WASHINGTON (AP) – The agency that oversees the nation’s health care program for the poor has yet to put into practice several recommendations that federal auditors made four years ago to cut down on waste and fraud.

Auditors with the Government Accountability Office said the agency that oversees Medicaid spending is doing some things better. It has hired 90 additional workers to track inappropriate reimbursements, and it has found at least $2.3 billion dollars in questionable reimbursement claims since the last review.

Yet serious weaknesses identified in the 2002 report remain, particularly when it comes to crunching payment data that states must submit on tapes. The database is so massive that the Centers for Medicare and Medicaid Services hasn’t figured out a way to make it workable for fraud experts out in the field. Only a few employees in the agency can access the data.

“The Medicaid program represents the best of intentions and the worst of execution,” said Sen. Charles Grassley of Iowa, the Republican chairman of the Senate Finance Committee, who requested the review.

Also, the agency has failed to create profiles for each state that would include such information as steps the states took to screen health care providers, or studies that documented the rate of inaccurate payments. Such profiles should also be shared with workers who review payments for accuracy, so they have a better feel of where to look for problems.

Overall, auditors counted six of 13 recommendations made in 2002 as implemented.

Mark McClellan, who oversees the Medicaid program, had a much more positive reaction to the auditors’ report. He said the findings “clearly reflect CMS’s ongoing commitment to the fiscal integrity of the Medicaid program.”

For instance, he said the auditors acknowledged improved efforts in monitoring state claims for reimbursement. He said the agency would examine all the issues raised by the auditors.

But Grassley, whose committee has jurisdiction over Medicaid in the Senate, said the agency needs to take all of the auditors’ recommendations to heart this time.

“CMS needs to act today, so that we don’t have another report like this one four years from now,” Grassley said.

Medicaid is a state-federal partnership. More than $300 billion is spent on the program annually. The federal government picks up about 60 percent of that total.

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Government Accountability Office: http://www.gao.gov