MEDICARE FRAUD

Further Actions Needed to 

Address Fraud, Waste, and 

Abuse

Statement of Kathleen M. King 

Director, Health Care

Testimony 

Before the Subcommittee on Oversight 

and Investigations, Committee on 

Energy and Commerce, House of 

Representatives

For Release on Delivery 

Expected at 10:00 a.m. ET

Wednesday, June 25, 2014

GAO-14-712T

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-14-712T, a testimony 

before the Subcommittee on Oversight and 

Investigations, Committee on Energy and

Commerce, House of Representatives

June 25, 2014

MEDICARE FRAUD

Further Actions Needed to Address Fraud, Waste, 

and Abuse

Why GAO Did This Study

GAO has designated Medicare as a 

high-risk program, in part because the 

program’s size and complexity make it 

vulnerable to fraud, waste, and abuse. 

In 2013, Medicare financed health care 

services for approximately 51 million 

individuals at a cost of about 

$604 billion. The deceptive nature of 

fraud makes its extent in the Medicare 

program difficult to measure in a 

reliable way, but it is clear that fraud 

contributes to Medicare’s fiscal 

problems. More broadly, in fiscal year 

2013, CMS estimated that improper 

payments—some of which may be 

fraudulent—were almost $50 billion.

This statement focuses on the 

progress made and important steps to 

be taken by CMS and its program 

integrity contractors to reduce fraud in 

Medicare. This statement is based on 

relevant GAO products and 

recommendations issued from 2004 

through 2014 using a variety of 

methodologies. Additionally, in June 

2014, GAO updated information based

on new regulations regarding 

enrollment of certain providers in 

Medicare by examining public 

documents.

What GAO Found

The Centers for Medicare & Medicaid Services (CMS)—the agency within the 

Department of Health and Human Services (HHS) that oversees Medicare—has 

made progress in implementing several key strategies GAO identified or 

recommended in prior work as helpful in protecting Medicare from fraud; 

however, implementing other important actions that GAO recommended could 

help CMS and its program integrity contractors combat fraud. These strategies 

are:

Provider and Supplier Enrollment: The Patient Protection and Affordable Care 

Act (PPACA) authorized, and CMS has implemented, actions to strengthen 

provider and supplier enrollment that address past weaknesses identified by 

GAO and HHS’s Office of Inspector General. For example, CMS has hired 

contractors to determine whether providers and suppliers have valid licenses and 

are at legitimate locations. CMS could further strengthen enrollment screening by 

issuing a rule to require additional provider and supplier disclosures of 

information, such as any suspension of payments from a federal health care 

program, and establishing core elements for provider and supplier compliance 

programs, as authorized by PPACA.

Prepayment and Postpayment Claims Review: Medicare uses prepayment 

review to deny claims that should not be paid and postpayment review to recover 

improperly paid claims. GAO has found that increased use of prepayment edits 

could help prevent improper Medicare payments. For example, prior GAO work 

identified millions of dollars of payments that appeared to be inconsistent with 

selected coverage and payment policies and therefore improper. Postpayment 

reviews are also critical to identifying and recouping overpayments. GAO 

recommended better oversight of both (1) the information systems analysts use 

to identify claims for postpayment review, in a 2011 report, and (2) the 

contractors responsible for these reviews, in a 2013 report. CMS has taken 

action or has actions under way to address these recommendations.

Addressing Identified Vulnerabilities: Having mechanisms in place to resolve 

vulnerabilities that could lead to improper payments is critical to effective 

program management and could help address fraud. However, prior GAO work 

has shown weaknesses in CMS’s processes to address such vulnerabilities. For 

example, GAO has made multiple recommendations to CMS to remove Social 

Security numbers from beneficiaries’ Medicare cards to help prevent identity 

theft. HHS agreed with these recommendations, but reported that CMS could not 

proceed with the changes for a variety of reasons, including funding limitations, 

and therefore has not taken action.

GAO work under way addressing these key strategies includes examining: 

(1) how well CMS’s information system can prevent and detect the continued 

enrollment of ineligible or potentially fraudulent providers and suppliers in 

Medicare, (2) the potential use of electronic-card technologies to help reduce 

Medicare fraud, (3) CMS’s oversight of program integrity efforts for prescription 

drugs, and (4) CMS’s oversight of some of the contractors that conduct reviews 

of claims after payment. These studies could help CMS more systematically 

reduce potential fraud in the Medicare program.

View GAO-14-712T. For more information, 

contact Kathleen M. King at (202) 512-7114 or 

kingk@gao.gov.
 

Page 1 GAO-14-712T

Chairman Murphy, Ranking Member DeGette, and Members of the 

Subcommittee:

I am pleased to be here today to discuss our work examining fraud in the 

Medicare program.1 We have designated Medicare as a high-risk 

program since 1990, in part because we found the program’s size and 

complexity make it vulnerable to fraud, waste, and abuse.2 Although there 

have been convictions for multimillion-dollar schemes that defrauded the 

Medicare program, the extent of the problem is unknown.3

In 2013, Medicare financed health care services for approximately 

51 million individuals at a cost of about $604 billion and reported some of 

the largest estimates of improper payments among federal programs—

payments that either were made in an incorrect amount or should not 

There are no 

reliable estimates of the extent of fraud in the Medicare program or for the 

health care industry as a whole. By its very nature, fraud is difficult to 

detect, as those involved are engaged in intentional deception. For 

example, a provider submitting a fraudulent claim may include false 

documentation to substantiate a service not provided, and thus the claim 

may appear valid on its face. Fraud may also involve payments made to 

beneficiaries to obtain their Medicare number for fraudulent billing 

purposes. Although the full extent of the problem is unknown, it is clear 

that, as one of the largest programs in the federal government, the 

Medicare program is vulnerable to fraud, contributing to its fiscal 

problems.

 

1

Medicare is the federally financed health insurance program for persons age 65 or over, 

certain individuals with disabilities, and individuals with end-stage renal disease.

2

In 1990, we began to report on government operations that we identified as “high risk” for 

serious weaknesses in areas that involve substantial resources and provide critical 

services to the public. Medicare has been included among such programs since 1990. 

See GAO, High-Risk Series: An Update, GAO-13-283 (Washington, D.C.: February 2013).

3

Fraud involves an intentional act or representation to deceive with the knowledge that the 

action or representation could result in gain.
 

Page 2 GAO-14-712T

have been made at all.4 The Centers for Medicare & Medicaid Services 

(CMS), the agency within the Department of Health and Human Services

(HHS) that oversees Medicare, has estimated that improper payments in 

the Medicare program were almost $50 billion in fiscal year 2013, about 

$5 billion higher than in 2012.5 Improper payments may be a result of 

fraud, waste, or abuse, but it is important to distinguish that the $50 billion 

in estimated improper payments reported by CMS in fiscal year 2013 is 

not an estimate of fraud in Medicare.6

Since its inception, Medicare has been administered largely by 

contractors with federal oversight, and these contractors have a 

responsibility to help ensure Medicare program integrity.

Reported improper payment 

estimates include many types of payments that should not have been 

made or were made in an incorrect amount such as overpayments, 

underpayments, and payments that were not adequately documented.

7

 

4

Improper payments may be a result of fraud, waste, or abuse. They are any payments 

that should not have been made or that were made in an incorrect amount (including 

overpayments and underpayments) under statutory, contractual, administrative, or other 

legally applicable requirements. This definition includes any payment to an ineligible 

recipient, any payment for an ineligible good or service, any duplicate payment, any 

payment for a good or service not received (except where authorized by law), and any 

payment that does not account for credit for applicable discounts. Improper Payments 

Elimination and Recovery Act of 2010, Pub. L. No. 111-204, § 2(e), 124 Stat. 2224, 2227 

(codified at 31 U.S.C. § 3321 note). 

CMS must 

oversee their efforts to help ensure proper payments and address the 

program’s many vulnerabilities, which include service- or system-specific 

weaknesses that can lead to payment errors, including those due to 

5

A list of abbreviations used in this statement is provided in app. I.

6

Waste includes inaccurate payments for services, such as unintentional duplicate 

payments. Abuse represents actions inconsistent with acceptable business or medical 

practices.

7

The Medicare program consists of four parts: A, B, C, and D. Medicare Parts A and B are 

known as Medicare fee-for-service (FFS). Medicare Part A covers hospital and other 

inpatient stays. Medicare Part B is optional, and covers hospital outpatient, physician, and 

other services. Medicare beneficiaries have the option of obtaining coverage for Medicare 

services from private health plans that participate in Medicare Advantage—Medicare’s 

managed care program—also known as Part C. All Medicare beneficiaries may purchase 

coverage for outpatient prescription drugs under Part D, either as a stand-alone benefit or 

as part of a Medicare Advantage plan. Contractors are responsible for administering 

Medicare FFS claims and conducting activities to reduce improper payments.
 

Page 3 GAO-14-712T

fraud.8 If CMS suspects that providers or suppliers are billing fraudulently, 

it can take action through its contractors, including suspending claims 

payment, revoking billing privileges, or referring cases to law enforcement 

for investigation.9

My statement today focuses on the progress made and important steps to 

be taken by CMS to reduce fraud in Medicare. It is primarily based on our 

Medicare program integrity products issued and recommendations made 

from April 2004 through May 2014,

10 as well as selected updates on 

actions CMS has taken, and will focus on progress related to three key 

strategies we have identified as important to reducing fraud, waste, and 

abuse, and ultimately improper payments:11

• strengthening provider and supplier enrollment standards and 

procedures,

• improving prepayment and postpayment review of claims, and

• addressing identified vulnerabilities.

In June 2014, we updated information based on new regulations 

regarding enrollment of certain providers in Medicare by examining public 

documents. Our work for this statement and the products on which it was 

based was conducted in accordance with generally accepted government 

auditing standards. Those standards require that we plan and perform the 

 

8

CMS defines vulnerabilities to the Medicare program as issues that can lead to fraud, 

waste, or abuse, which can be either specific, such as providers receiving multiple 

payments as a result of incorrect coding for a service, or general and programwide, such 

as weaknesses in online application processes. An example of a vulnerability that leads to 

improper payments is providers billing for more than one blood transfusion in a hospital 

outpatient setting for a Medicare beneficiary in a day, which Medicare policy does not 

allow.

9

In this testimony, the term provider includes entities such as hospitals or physicians, and 

supplier means entities such as ambulance service providers, mammography centers, and 

entities that supply Medicare beneficiaries with durable medical equipment, prosthetics, 

orthotics, and supplies (DMEPOS), such as walkers and wheelchairs. This testimony will 

use the term providers and suppliers when referring to all Medicare providers and 

suppliers but will specify other suppliers, such as DMEPOS suppliers, when necessary.

10The products listed at the end of this statement contain detailed information on the 

various methodologies used in our work.

11See GAO, Program Integrity: Further Action Needed to Address Vulnerabilities in 

Medicaid and Medicare Programs, GAO-12-803T (Washington, D.C.: June 7, 2012).
 

Page 4 GAO-14-712T

audit to obtain sufficient, appropriate evidence to provide a reasonable 

basis for our findings and conclusions based on our audit objectives. We 

believe that the evidence obtained provides a reasonable basis for our 

findings and conclusions based on our audit objectives.

Since 1996, Congress has taken important steps to increase Medicare 

program integrity funding and oversight, including the establishment of 

the Medicare Integrity Program. Table 1 summarizes several key 

congressional actions.

Table 1: Key Congressional Actions to Increase Medicare Program Integrity Funding and Oversight

Year Congressional action Statute 

1996 Created the Medicare Integrity Program and established dedicated funding for activities to 

address fraud, waste, and abuse in federal health care programs, including Medicare

Health Insurance Portability 

and Accountability Act of 

1996

a

2003

b

Directed CMS to conduct a 3-year demonstration project on the use of recovery audit 

contractors (RAC) for identifying and recouping Medicare underpayments and overpayments

Medicare Prescription Drug, 

Improvement, and 

Modernization Act of 2003

2006

c

Required CMS to implement a national RAC program by January 1, 2010 Tax Relief and Health Care 

Act of 2006

2010

d 

Provided additional funding for program integrity activities and, among other things

• established new provider enrollment requirements

• required CMS to extend the Medicare RACs to Parts C and D of the Medicare program

• required CMS to develop core elements for provider compliance programs

• authorized surety bond requirements for certain Medicare providers

Patient Protection and 

Affordable Care Act (PPACA)

e

2010

f

Required Medicare fee-for-service to begin using predictive analytics to identify and prevent 

fraud

Small Business Jobs Act of 

2010 g

Source: GAO analysis of selected federal laws. | GAO-14-712T 

h

a

The fund is known as the Health Care Fraud and Abuse Control account.

b

Pub. L. No. 104-191, §§ 201(b)-202, 110 Stat. 1936, 1993-98 (codified at 42 U.S. C. §§ 1395i(k), 

1395ddd).

c

Pub. L. No. 108-173, § 306, 117 Stat. 2066, 2256-57.

d

Pub. L. No. 109-432, div B., title III, § 302, 120 Stat. 2922, 2991-92 (codified at 42 U.S.C. § 1395 

ddd(h)).

e

A surety bond is a three-party agreement in which a company, known as a surety, agrees to 

compensate the bondholder if the bond purchaser fails to keep a specified promise.

f

Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education 

Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029. 

g

Predictive analytics include the use of algorithms and models to analyze claims before payment is 

made in order to identify unusual or suspicious patterns or abnormalities in provider networks, claims 

billing patterns, and beneficiary utilization.

h

Background

Pub. L. No. 111-240, § 4241, 124 Stat. 2504, 2599.
 

Page 5 GAO-14-712T

CMS has made progress in strengthening provider and supplier 

enrollment provisions, but needs to do more to identify and prevent 

potentially fraudulent providers and suppliers from participating in 

Medicare. Additional improvements to prepayment and postpayment 

claims review would help prevent and recover improper payments. 

Addressing payment vulnerabilities already identified could further help 

prevent or reduce fraud.

PPACA authorized and CMS has implemented new provider and supplier 

enrollment procedures that address past weaknesses identified by GAO 

and HHS’s Office of Inspector General (OIG) that allowed entities intent 

on committing fraud to enroll in Medicare. CMS has also implemented 

other measures intended to improve existing procedures. Specifically, to 

strengthen the existing screening activities conducted by CMS 

contractors, the agency added screenings of categories of provider and 

supplier enrollment applications by risk level, contracted with new national 

enrollment screening and site visit contractors, began imposing moratoria 

on new enrollment of certain types of providers and suppliers, and issued 

regulations requiring certain prescribers to enroll in Medicare.

CMS and OIG issued a final rule in February 2011 to implement many of 

the new screening procedures required by PPACA.12 CMS designated 

three levels of risk—high, moderate, and limited—with different screening 

procedures for categories of Medicare providers and suppliers at each 

level. Providers and suppliers in the high-risk level are subject to the most 

rigorous screening.13

 

12Medicare, Medicaid, and Children’s Health Insurance Programs; Additional Screening 

Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions 

and Compliance Plans for Providers and Suppliers, 76 Fed. Reg. 5862 (Feb. 2, 2011). In 

discussing the final rule, CMS noted that Medicare had already employed a number of the 

screening practices described in PPACA to determine whether a provider is in compliance 

with federal and state requirements to enroll or to maintain enrollment in the Medicare 

program.

(See table 2.) Based in part on our work and that of 

OIG, CMS designated newly enrolling home health agencies and 

13PPACA specified that the enhanced screening procedures apply to new providers and 

suppliers beginning 1 year after the date of enactment (March 23, 2010) and to currently 

enrolled providers and suppliers 2 years after that date.

CMS Has 

Strengthened 

Provider and Supplier 

Screening, but More 

Can Be Done to 

Improve Medicare 

Program Integrity

CMS Has Strengthened 

Certain Enrollment 

Screening Procedures 

since PPACA

Screening Provider and 

Supplier Enrollment 

Applications by Risk Level
 

Page 6 GAO-14-712T

suppliers of durable medical equipment, prosthetics, orthotics, and 

supplies (DMEPOS) as high risk, and designated other providers and 

suppliers as lower risk levels. Providers and suppliers at all risk levels are 

screened to verify that they meet specific requirements established by 

Medicare, such as having current licenses or accreditation and valid 

Social Security numbers.14 High- and moderate-risk providers and 

suppliers are also subject to unannounced site visits. Further, depending 

on the risks presented, PPACA authorizes CMS to require fingerprintbased criminal history checks. In March 2014, CMS awarded a contract 

that is to enable the agency to access Federal Bureau of Investigation 

information to help conduct those checks of high-risk providers and 

suppliers. PPACA also authorizes the posting of surety bonds for certain 

providers and suppliers.

15

Table 2: Categories of Medicare Providers and Suppliers Designated by Risk Level for Enrollment Screening

Risk level Categories of Medicare providers and suppliers

Limited Physician or nonphysician practitioners and medical groups or clinics, with the exception of physical therapists and 

physical therapy groups. Ambulatory surgical centers, competitive acquisition programs/Part B vendors, end-stage 

renal disease facilities, federally qualified health centers, histocompatibility laboratories,a hospitals including critical 

access hospitals, Indian Health Service facilities, mammography screening centers, mass immunization roster 

billers,b

Moderate

organ procurement organizations, pharmacies newly enrolling or revalidating, radiation therapy centers, 

religious nonmedical health care institutions, rural health clinics, and skilled nursing facilities.

Ambulance suppliers, community mental health centers, comprehensive outpatient rehabilitation facilities, hospice 

organizations, independent diagnostic testing facilities, independent clinical laboratories, physical therapy including 

physical therapy groups, portable X-ray suppliers, and currently enrolled (revalidating) home health agencies.

High Prospective (newly enrolling) home health agencies and prospective (newly enrolling) suppliers of durable medical 

equipment, prosthetics, orthotics, and supplies.

Source: GAO analysis of CMS regulations. | GAO-14-712T

a

The responsibility of the histocompatibility laboratory is to provide an evaluation of certain genetic 

data and pertinent patient immunologic risk factors that will allow the clinician and patient to decide 

which approaches to transplantation are in the patient’s best interest.

b

 

14Screening may include verification of the following: Social Security number; National 

Provider Identifier (NPI); National Practitioner Databank licensure; whether the provider 

has been excluded from federal health care programs by OIG; taxpayer identification 

number; and death of an individual practitioner, owner, authorized official, delegated 

official, or supervising physician.

Mass immunization roster billers are providers and suppliers who enroll in the Medicare program to 

offer the influenza (flu) vaccinations to a large number of individuals, and they must be properly 

licensed in the states in which they plan to operate influenza clinics.

15A surety bond is a three-party agreement in which a company, known as a surety, 

agrees to compensate the bondholder if the bond purchaser fails to keep a specified 

promise.
 

Page 7 GAO-14-712T

CMS has indicated that the agency will continue to review the criteria for 

its screening levels and will publish changes if the agency decides to 

update the assignment of screening levels for categories of Medicare 

providers and suppliers. Doing so could become important because the 

Department of Justice (DOJ) and HHS reported multiple convictions, 

judgments, settlements, or exclusions against types of providers and 

suppliers not currently at the high-risk level, including community mental 

health centers and ambulance suppliers.

16 CMS’s implementation of 

accreditation for DMEPOS suppliers, and of a competitive bidding 

program, including in geographic areas thought to have high fraud rates, 

may be helping to reduce the risk of DMEPOS fraud.17 While continued 

vigilance of DMEPOS suppliers is warranted, other types of providers 

may become more problematic in the future. Specifically, in September 

2012 we reported that a range of providers have been the subjects of 

fraud investigations.18 According to 2010 data from OIG and DOJ, over 

10,000 providers and suppliers that serve Medicare, Medicaid, and 

Children’s Health Insurance Program beneficiaries were involved in fraud 

investigations, including not only home health agencies and DMEPOS 

suppliers but also physicians, hospitals, and pharmacies.19

 

16Department of Health and Human Services and the Department of Justice, Health Care 

Fraud and Abuse Control Program Annual Report for Fiscal Year 2013 (Washington, D.C.: 

February 2014).

In addition, 

the provider type constituting the largest percentage of subjects in 

criminal health care fraud investigations was medical facilities—including 

medical centers, clinics, or practices—which constituted almost a quarter 

of subjects in such investigations. DMEPOS suppliers made up a little 

over 16 percent of subjects.

17Competitive bidding is a process in which suppliers of medical equipment and supplies 

compete for the right to provide their products on the basis of established criteria, such as 

quality and price. See GAO, Medicare: Second Year Update for CMS’s Durable Medical 

Equipment Competitive Bidding Program Round 1 Rebid, GAO-14-156 (Washington, D.C.: 

Mar. 7, 2014).

18GAO, Health Care Fraud: Types of Providers Involved in Medicare, Medicaid, and the 

Children’s Health Insurance Program Cases, GAO-12-820 (Washington, D.C.: Sept. 7, 

2012).

19Medicaid is the federal-state program that covers acute health care, long-term care, and 

other services for certain low-income people. It is also one of the largest components of 

state budgets. Children’s Health Insurance Program is the joint federal-state program that 

provides health coverage to children whose families have incomes that are low, but not 

low enough to qualify for Medicaid.
 

Page 8 GAO-14-712T

We are currently examining the ability of CMS’s provider and supplier

enrollment system to prevent and detect the continued enrollment of 

ineligible or potentially fraudulent providers and suppliers in Medicare. 

Specifically, we are assessing the process used to enroll and verify the 

eligibility of Medicare providers and suppliers in Medicare’s Provider 

Enrollment, Chain, and Ownership System (PECOS) and the extent to 

which CMS’s controls are designed to prevent and detect the continued 

enrollment of potentially ineligible or fraudulent providers and suppliers in 

PECOS. We plan to issue a report this winter.

CMS contracted with two new types of entities at the end of 2011 to 

assume centralized responsibility for two functions that had been the 

responsibility of multiple contractors. One of the new contractors is 

conducting automated screenings to check that existing and newly 

enrolling providers and suppliers have valid licensure, accreditation, and 

a National Provider Identifier (NPI), and are not on the OIG list of 

providers and suppliers excluded from participating in federal health care 

programs. The second contractor conducts site visits of providers and 

suppliers, except for DMEPOS suppliers, to determine whether sites are 

legitimate and the providers and suppliers meet certain Medicare 

standards.20 A CMS official reported that, since the implementation of the 

PPACA screening requirements, the agency had revoked over 17,000 

suspect providers’ and suppliers’ ability to bill the Medicare program.21

CMS has suspended enrollment of new home health providers and 

ground ambulance suppliers in certain fraud “hot spots” and other 

geographic areas. In July 2013, CMS first exercised its authority granted 

by PPACA to establish temporary moratoria on enrolling new home health 

agencies in Chicago and Miami, and new ambulance suppliers in 

Houston.22

 

20Site visits for DMEPOS suppliers are to continue to be conducted by the contractor 

responsible for their enrollment. In addition, CMS at times exercises its authority to 

conduct a site visit or request its contractors to conduct a site visit for any Medicare 

provider or supplier.

In January 2014, CMS extended its first moratoria and added 

21S. Agrawal, M.D., Deputy Administrator and Director, Center for Program Integrity, 

Centers for Medicare & Medicaid Services, Preventing Medicare Fraud: How Can We 

Best Protect Seniors and Taxpayers?, testimony before the Senate Special Aging 

Committee, 113th Cong., 2nd sess., March 26, 2014.

22Under the moratoria, existing providers and suppliers can continue to deliver and bill for 

services, but no new provider and supplier applications will be approved in these areas. 

CMS re-evaluates the need for such moratoria every 6 months.

Implementing National 

Enrollment Screening and Site 

Visit Contractors

Establishing Moratoria on 

Enrollment of New Providers 

and Suppliers in Certain Areas
 

Page 9 GAO-14-712T

enrollment moratoria for new home health agency providers in Fort 

Lauderdale, Detroit, Dallas, and Houston, and new ambulance suppliers 

in Philadelphia. These moratoria are scheduled to be in effect until July 

2014, unless CMS extends or lifts them. CMS officials cited areas of 

potential fraud risk, such as a disproportionate number of providers and 

suppliers relative to beneficiaries and extremely high utilization as 

rationales for suspending new enrollments of home health providers or 

ground ambulance suppliers in these areas.

CMS recently issued a final rule requiring prescribers of drugs covered 

within Medicare’s prescription drug program, Part D, to enroll in Medicare 

by June 2015.23 As a result of this rule, CMS is to screen these 

prescribers to verify that they meet specific requirements, such as having 

current licenses or accreditation and valid Social Security numbers. OIG 

has identified concerns with CMS oversight of fraud, waste, and abuse in 

Part D, including the contractors tasked with this work. A June 2013 OIG 

report found that the Part D program inappropriately paid for drugs 

ordered by individuals who clearly did not have the authority to prescribe, 

such as massage therapists, athletic trainers, home contractors, and 

interpreters.24 OIG recommended, among other things, that there should 

be verification of prescribers’ authority to prescribe drugs, and that CMS 

should ensure that Medicare does not pay for prescriptions from 

individuals without such authority. CMS agreed with OIG’s 

recommendations and, in discussing the final rule, stated that this new 

enrollment requirement is to help ensure that Part D drugs are prescribed 

only by qualified physicians and eligible professionals. To continue to help 

address potential vulnerabilities in the Part D program, we are currently 

examining practices for promoting prescription drug program integrity and 

the extent to which CMS’s oversight of Medicare Part D reflects those 

practices. We plan to issue a report this fall.

 

23Medicare Program: Contract Year 2015 Policy and Technical Changes to the Medicare 

Advantage and the Medicare Prescription Drug Benefit Programs. 79 Fed. Reg. 29,844

(May 23, 2014).

24Department of Health and Human Services, Office of Inspector General, Medicare 

Inappropriately Paid for Drugs Ordered by Individuals Without Prescribing Authority, OEI02-09-00608 (June 21, 2013).

Requiring Certain Prescribers 

to Enroll in Medicare
 

Page 10 GAO-14-712T

Although CMS has taken many needed actions, we and OIG have found 

that CMS has not fully implemented other enrollment screening actions 

authorized by PPACA.25

PPACA authorized CMS to require a surety bond for certain types of atrisk providers and suppliers. Surety bonds may serve as a source for 

recoupment of erroneous payments. DMEPOS suppliers are currently 

required to post a surety bond at the time of enrollment.

These actions could help further reduce the 

enrollment of providers and suppliers intent on defrauding the Medicare 

program, which is important because identifying and prosecuting 

providers and suppliers engaged in potentially fraudulent activity is time 

consuming, resource intensive, and costly. These actions include issuing 

a rule to implement surety bonds for certain providers and suppliers, 

issuing a rule on provider and supplier disclosure requirements, and 

establishing the core elements for provider and supplier compliance 

programs.

26

CMS has not yet scheduled a proposed rule for publication for increased 

disclosures of prior actions taken against providers and suppliers 

enrolling or revalidating enrollment in Medicare, as authorized by PPACA, 

such as whether the provider or supplier has been subject to a payment 

CMS reported 

in April 2014 that it had not yet scheduled for publication a proposed rule 

to implement the PPACA surety bond requirement for other types of atrisk providers and suppliers—such as home health agencies and 

independent diagnostic testing facilities. In light of the moratoria that CMS 

has placed on enrollment of home health agencies in fraud “hot spots,” 

implementation of this rule could help the agency address potential 

concerns for these at-risk providers across the Medicare program.

 

25GAO, Medicare Program Integrity: CMS Continues Efforts to Strengthen the Screening 

of Providers and Suppliers, GAO-12-351 (Washington, D.C.: Apr. 10, 2012).

2642 U.S.C. § 1395m(a)(16)(B). A DMEPOS surety bond is a bond issued by an entity 

guaranteeing that a DMEPOS supplier will fulfill its obligation to Medicare. If the obligation 

is not met, the surety bond is paid to Medicare. Medicare Program; Surety Bond 

Requirement for Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and 

Supplies (DMEPOS), 74 Fed. Reg. 166 (Jan. 2, 2009).

Additional Enrollment 

Screening Could Help 

Ensure Potentially 

Fraudulent Providers and 

Suppliers Do Not 

Participate in Medicare

Surety Bonds

Providers and Suppliers 

Disclosure
 

Page 11 GAO-14-712T

suspension from a federal health care program.27

CMS has not established the core elements of compliance programs for 

providers and suppliers, as required by PPACA. We previously reported 

that agency officials indicated that they had sought public comments on 

the core elements, which they were considering, and were also studying 

criteria found in OIG model plans for possible inclusion.

Agency officials had 

indicated that developing the additional disclosure requirements has been 

complicated by provider and supplier concerns about what types of 

information will be collected, what CMS will do with it, and how the 

privacy and security of this information will be maintained.

28 As of April 

2014, CMS reported that it had not yet scheduled a proposed rule for 

publication.

Medicare uses prepayment review to deny claims that should not be paid 

and postpayment review to recover improperly paid claims. As claims go 

through Medicare’s electronic claims payment systems, they are 

subjected to prepayment controls called “edits,” most of which are fully 

automated; if a claim does not meet the criteria of the edit, it is 

automatically denied.29

 

27At the time of initial enrollment or revalidation of enrollment, PPACA requires providers 

and suppliers to disclose, in a form and manner and at such time as determined by the 

Secretary, any current or previous affiliation with another provider or supplier that has 

uncollected debt; has been or is subject to a payment suspension under a federal health 

care program; has been excluded from participation under Medicare, Medicaid, or State 

Children’s Health Insurance Program; or has had its billing privileges denied or revoked. 

Pub. L. No. 111-148, § 6401(a), 124 Stat. 119, 750 (2010).

Other prepayment edits are manual; they flag a 

claim for individual review by trained staff who determine whether it 

should be paid. Due to the volume of claims, CMS has reported that less 

28A compliance program is an internal set of policies, processes, and procedures that a 

provider organization implements to help it act ethically and lawfully. In this context, a 

compliance program is intended to help provider and supplier organizations prevent and 

detect violations of Medicare laws and regulations. OIG has developed a series of 

voluntary compliance program guidance documents directed at various segments of the 

health care industry, such as hospitals, nursing homes, third-party billers, and durable 

medical equipment suppliers, to encourage the development and use of internal controls 

to monitor adherence to applicable statutes, regulations, and program requirements. 

29Edits are instructions programmed in the systems to prevent payment of incomplete or 

incorrect claims. Some edits use provider enrollment information, while others use 

information on coverage or payment policies, to determine whether claims should be paid.

Compliance Program

Further Improvements to 

Prepayment and 

Postpayment Claims 

Review May Better Identify 

or Recover Improper 

Payments
 

Page 12 GAO-14-712T

than 1 percent of Medicare claims are subject to manual medical record 

review by trained personnel.

Increased use of prepayment edits could help prevent improper Medicare 

payments. Our prior work found that, while use of prepayment edits saved 

Medicare at least $1.76 billion in fiscal year 2010, the savings could have 

been greater had prepayment edits been used more widely.30 Based on 

an analysis of a limited number of national policies and local coverage 

determinations (LCD), we identified $14.7 million in payments in fiscal 

year 2010 that appeared to be inconsistent with four national policies and 

therefore improper.31 We also found more than $100 million in payments 

that were inconsistent with three selected LCDs that could have been 

identified using automated edits. Thus, we concluded that more 

widespread implementation of effective automated edits developed by 

individual MACs in other MAC jurisdictions could also result in savings to 

Medicare. CMS has taken steps to improve the development of other 

types of prepayment edits that are implemented nationwide, as we 

recommended. For example, the agency has centralized the development 

and implementation of automated edits based on a type of national policy 

called national coverage determinations.32

 

30See GAO, Medicare Program Integrity: Greater Prepayment Control Efforts Could 

Increase Savings and Better Ensure Proper Payment, 

CMS has also modified its 

processes for identifying provider billing of services that are medically 

GAO-13-102 (Washington, D.C.: 

Nov. 13, 2012).

31Each Medicare administrative contractor (MAC) has the authority to develop LCDs that 

delineate the circumstances under which services are considered reasonable and 

necessary and are therefore covered in the geographic area where that MAC processes 

claims. These local policies cannot conflict with national coverage and payment policies 

established by CMS or by law. MACs’ authority to develop LCDs leads to differences in 

Medicare coverage policy in different areas of the country. MACs may create prepayment 

edits either to implement their LCDs or to implement national Medicare policies set by 

CMS, although not every LCD or national policy is structured in a way that makes edit 

development feasible. CMS has responsibility for providing information and oversight to 

MACs with respect to their use of prepayment edits to promote effective stewardship of 

Medicare funds.

32CMS typically develops national coverage determinations for services that have the 

potential to affect a large number of beneficiaries and that have the greatest effect on the 

Medicare program. Development of national coverage determinations is a lengthy 

process, which requires review of clinical evidence and allows for public comment.
 

Page 13 GAO-14-712T

unlikely to prevent circumvention of automated edits designed to identify 

an unusually large quantity of services provided to the same patient.33

We also evaluated the implementation of CMS’s Fraud Prevention 

System (FPS), which uses predictive analytic technologies as required by 

the Small Business Jobs Act of 2010 to analyze Medicare fee-for-service 

(FFS) claims on a prepayment basis. FPS identifies investigative leads for 

CMS’s Zone Program Integrity Contractors (ZPIC), the contractors 

responsible for detecting and investigating potential fraud.34 Implemented 

in July 2011, FPS is intended to help facilitate the agency’s shift from 

focusing on recovering potentially fraudulent payments after they have 

been made, to detecting aberrant billing patterns as quickly as possible, 

with the goal of preventing these payments from being made. However, in 

October 2012, we found that, while FPS generated leads for 

investigators, it was not integrated with Medicare’s payment-processing 

system to allow the prevention of payments until suspect claims can be 

determined to be valid. As of April 2014, CMS reported that while the FPS 

functionality to deny claims before payment had been integrated with the 

Medicare payment processing system in October 2013, the system did 

not have the ability to suspend payment until suspect claims could be 

investigated. In addition, while CMS directed the ZPICs to prioritize alerts 

generated by the system, in our work examining the sources of new ZPIC 

investigations in 2012, we found that FPS accounted for about 5 percent 

of ZPIC investigations in that year.35 A CMS official reported in March 

2014 that ZPICs are now using FPS as a primary source of leads for 

fraud investigations, though the official did not provide details on how 

much of ZPICs’ work is initiated through the system.36

 

33CMS refers to these as Medically Unlikely Edits. These edits are designed to deny 

payment for services where the number of units billed exceeds the maximum number a 

provider would bill under most circumstances for a beneficiary on a single date of service.

34GAO, Medicare Fraud Prevention: CMS Has Implemented a Predictive Analytics 

System, but Needs to Define Measures to Determine Its Effectiveness, GAO-13-104

(Washington, D.C.: Oct. 15, 2012).

35GAO, Medicare Program Integrity: Contractors Reported Generating Savings, but CMS 

Could Improve Its Oversight, GAO-14-111 (Washington, D.C.: Oct. 25, 2013).

36S. Agrawal, Preventing Medicare Fraud, testimony before the Senate Special Aging 

Committee, March 26, 2014. Additionally, CMS has not published a report detailing the 

results of the second year of implementation of the FPS system, as required by the Small 

Business Jobs Act of 2010. The report was due in 2013.
 

Page 14 GAO-14-712T

Our prior work found that postpayment reviews are critical to identifying 

and recouping overpayments.37 The use of national recovery audit 

contractors (RAC)38 in the Medicare program is helping to identify 

underpayments and overpayments on a postpayment basis.39 CMS 

began the program in March 2009 for Medicare FFS.40 CMS reported 

that, as of the end of 2013, RACs collected $816 million for fiscal year 

2014.41

Other contractors help CMS investigate potentially fraudulent FFS 

payments, but CMS could improve its oversight of their work. CMS 

contracts with ZPICs in specific geographic zones covering the nation. In 

October 2013, we found that the ZPICs reported that their actions, such 

as stopping payments on suspect claims, resulted in more than $250 

million in savings to Medicare in calendar year 2012.

PPACA required the expansion of Medicare RACs to Parts C and 

D. CMS has implemented a RAC for Part D, and CMS said it plans to 

award a contract for a Part C RAC by the end of 2014. Moreover, in 

February 2014, CMS announced a “pause” in the RAC program as the 

agency makes changes to the program and starts a new procurement 

process for the next round of recovery audit contracts for Medicare FFS 

claims. CMS stated it anticipates awarding all five of these new Medicare 

FFS recovery audit contracts by the end of summer 2014.

42

 

37See GAO, Medicare Fraud, Waste, and Abuse: Challenges and Strategies for 

Preventing Improper Payments, 

However, CMS 

lacks information on the timeliness of ZPICs’ actions—such as the time it 

takes between identifying a suspect provider and taking actions to stop 

GAO-10-844T (Washington, D.C.: June 15, 2010).

38These contractors are also referred to as Recovery Auditors.

39Recovery auditing has been used in various industries, including health care, to identify 

and collect overpayments for about 40 years.

40The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 directed 

CMS to conduct a demonstration of the use of RACs in identifying underpayments and 

overpayments, and recouping overpayments in Medicare. Pub. L. No. 108-173, § 306, 

117 Stat. 2066, 2256-57. Subsequently, the Tax Relief and Health Care Act of 2006 

required CMS to implement a national RAC program by January 1, 2010. Pub. L. No. 109-

432, div. B, title III, § 302, 120 Stat. 2922, 2991 (codified at 42 U.S.C. § 1395ddd(h)).

41See Centers for Medicare & Medicaid Services, Medicare Fee for Service, National 

Recovery Audit Program, Quarterly Newsletter, accessed Apr. 17, 2014, 

http://www.cms.gov/Research-Statistics-Data-and-Systems/MonitoringPrograms/Medicare-FFS-Compliance-Programs/Recovery-AuditProgram/Downloads/Medicare-FFS-Recovery-Audit-Program-1st-qtr-2014.pdf. 

42GAO-14-111. 
 

Page 15 GAO-14-712T

that provider from receiving potentially fraudulent Medicare payments—

and would benefit from knowing whether ZPICs could save more money 

by acting more quickly. Thus we recommended that CMS collect and 

evaluate information on the timeliness of ZPICs’ investigative and 

administrative actions. CMS did not provide comments on our 

recommendation. We are currently examining the activities of the CMS 

contractors, including ZPICs, that conduct postpayment claims reviews, 

and anticipate issuing a report later this summer. Our work is reviewing, 

among other things, whether CMS has a strategy for coordinating these 

contractors’ postpayment claims review activities.

CMS has taken steps to improve use of two CMS information technology 

systems that could help analysts identify fraud after claims have been 

paid, but further action is needed. In 2011, we found that the Integrated 

Data Repository (IDR)—a central data store of Medicare and other data 

needed to help CMS program integrity staff and contractors detect 

improper payments of claims—did not include all the data that were 

planned to be incorporated by fiscal year 2010, because of technical 

obstacles and delays in funding.43 As of March 2014, the agency had not 

addressed our recommendation, to develop reliable schedules to 

incorporate all types of IDR data, which could lead to additional delays in 

making available all of the data that are needed to support enhanced 

program integrity efforts and achieve the expected financial benefits. 

However, One Program Integrity (One PI)—a web-based portal intended 

to provide CMS staff and contractors with a single source of access to 

data contained in IDR, as well as tools for analyzing those data—is 

operational, and CMS has established plans and schedules for training all 

intended One PI users, as we also recommended in 2011. However, as of 

March 2014, CMS had not established deadlines for program integrity 

contractors to begin using One PI, as we recommended in 2011. Without 

these deadlines, program integrity contractors will not be required to use 

the system, and as a result, CMS may fall short in its efforts to ensure the 

widespread use and to measure the benefits of One PI for program 

integrity purposes.

 

43GAO, Fraud Detection Systems: Centers for Medicare and Medicaid Services Needs to 

Ensure More Widespread Use, GAO-11-475 (Washington, D.C.: June 30, 2011).
 

Page 16 GAO-14-712T

Having mechanisms in place to resolve vulnerabilities that could lead to 

improper payments, some of which are potentially fraudulent, is critical to 

effective program management, but our work has shown weaknesses in 

CMS’s processes to address such vulnerabilities.44 Both we and OIG 

have made recommendations to CMS to improve the tracking of 

vulnerabilities. In our March 2010 report on the RAC demonstration 

program, we found that CMS had not established an adequate process 

during the demonstration or in planning for the national program to ensure 

prompt resolution of vulnerabilities that could lead to improper payments 

in Medicare; further, the majority of the most significant vulnerabilities 

identified during the demonstration were not addressed.45 In December 

2011, OIG found that CMS had not resolved or taken significant action to 

resolve 48 of 62 vulnerabilities reported in 2009 by CMS contractors 

specifically charged with addressing fraud.46 We and OIG recommended 

that CMS have written procedures and time frames to ensure that 

vulnerabilities were resolved. CMS has indicated that it is now tracking 

vulnerabilities identified from several types of contractors through a single 

vulnerability tracking process, and the agency has developed some 

written guidance on the process. In 2012, we examined that process and 

found that, while CMS informs Medicare administrative contractors (MAC) 

about vulnerabilities that could be addressed through prepayment edits, 

the agency does not systematically compile and disseminate information 

about effective local edits to address such vulnerabilities.47

 

44Federal internal control standards state that an agency should have policies and 

procedures to ensure that (1) the findings of all audits and reviews are promptly evaluated, 

(2) decisions are made about the appropriate response to these findings, and (3) actions 

are taken to correct or resolve the issues promptly. These are all aspects of internal 

control, which is the component of an organization’s management that provides 

reasonable assurance that the organization achieves effective and efficient operations, 

reliable financial reporting, and compliance with applicable laws and regulations. Internal 

control standards provide a framework for identifying and addressing major performance 

challenges and areas at greatest risk for mismanagement. See GAO, Internal Control 

Standards: Internal Control Management and Evaluation Tool, 

Specifically, 

GAO-01-1008G

(Washington, D.C.: August 2001).

45GAO, Medicare Recovery Audit Contracting: Weaknesses Remain in Addressing 

Vulnerabilities to Improper Payments, Although Improvements Made to Contractor 

Oversight, GAO-10-143 (Washington, D.C.: Mar. 31, 2010).

46Department of Health and Human Services, Office of Inspector General, Addressing 

Vulnerabilities Reported by Medicare Benefit Integrity Contractors, OEI-03-10-00500 

(December 2011).

47GAO-13-102. 

Addressing Identified 

Vulnerabilities Could Help 

Reduce Fraud
 

Page 17 GAO-14-712T

we recommended that CMS require MACs to share information about the 

underlying policies and savings related to their most effective edits, and 

CMS generally agreed to do so. In addition, in 2011 CMS began requiring 

MACs to report on how they had addressed certain vulnerabilities to 

improper payment, some of which could be addressed through edits.

We also made recommendations to CMS to address the millions of 

Medicare cards that display beneficiaries’ Social Security numbers, which 

increases beneficiaries’ vulnerability to identity theft.48

In conclusion, although CMS has taken some important steps to identify 

and prevent fraud through increased provider and supplier screening and 

other actions, the agency must continue to improve its efforts to reduce 

fraud, waste, and abuse in the Medicare program. Identifying the nature, 

extent, and underlying causes of improper payments, and developing 

adequate corrective action processes to address vulnerabilities, are 

essential prerequisites to reducing them. As CMS continues its 

implementation of PPACA and Small Business Jobs Act provisions, 

In August 2012, we 

recommended that CMS (1) select an approach for removing Social 

Security numbers from Medicare cards that best protects beneficiaries 

from identity theft and minimizes burdens for providers, beneficiaries, and 

CMS; and (2) develop an accurate, well-documented cost estimate for 

such an option. In September 2013, we further recommended that CMS 

(1) initiate an information technology project for identifying, developing, 

and implementing changes for the removal of Social Security numbers; 

and (2) incorporate such a project into other information technology 

initiatives. HHS concurred with our recommendations and agreed that 

removing the numbers from Medicare cards is an appropriate step toward 

reducing the risk of identity theft. However, the department also stated

that CMS could not proceed with changes without agreement from other 

agencies, such as the Social Security Administration, and that funding 

was also a consideration. Thus, CMS has not yet taken action to address 

these recommendations. We are currently examining other options for 

updating and securing Medicare cards, including the potential use of 

electronic-card technologies, and expect to issue a report early next year. 

 

48GAO, Medicare Information Technology: Centers for Medicare and Medicaid Services 

Needs to Pursue a Solution for Removing Social Security Numbers from Cards, 

GAO-13-761 (Washington, D.C.: Sept. 10, 2013) and GAO, CMS Needs an Approach and 

a Reliable Cost Estimate for Removing Social Security Numbers from Medicare Cards, 

GAO-12-831 (Washington, D.C.: Aug. 1, 2012).
 

Page 18 GAO-14-712T

additional evaluation and oversight will help determine whether 

implementation of these provisions has been effective in reducing 

improper payments. We are investing resources in a body of work that 

assesses CMS’s efforts to refine and improve its fraud detection and 

prevention abilities. Notably, we are currently assessing potential use of 

electronic-card technologies, which can help reduce Medicare fraud. We 

are also examining the extent to which CMS’s information system can 

help prevent and detect the continued enrollment of ineligible or 

potentially fraudulent providers and suppliers in Medicare. Additionally, 

we have a study under way examining CMS’s oversight of fraud, waste, 

and abuse in Medicare Part D to determine whether the agency has 

adopted certain practices for ensuring the integrity of that program. We 

are also examining CMS’s oversight of some of the contractors that 

conduct reviews of claims after payment. These studies are focused on 

additional actions for CMS that could help the agency more systematically 

reduce potential fraud in the Medicare program.

Chairman Murphy, Ranking Member DeGette, and Members of the 

Subcommittee, this concludes my prepared remarks. I would be pleased 

to respond to any questions you may have at this time.

For further information about this statement, please contact 

Kathleen M. King at (202) 512-7114 or kingk@gao.gov. Contact points 

for our Offices of Congressional Relations and Public Affairs may be 

found on the last page of this statement. Karen Doran, Assistant Director; 

Eden Savino; and Jennifer Whitworth were key contributors to this 

statement.

GAO Contact and 

Staff 

Acknowledgments
Appendix I: Abbreviations

Page 19 GAO-14-712T

CMS Centers for Medicare & Medicaid Services

DMEPOS durable medical equipment, prosthetics, orthotics, and 

 supplies

DOJ Department of Justice

FFS fee-for-service 

FPS Fraud Prevention System

HHS Department of Health and Human Services

IDR Integrated Data Repository

LCD local coverage determination

MAC Medicare administrative contractor

NPI National Provider Identifier

OIG Office of Inspector General

One PI One Program Integrity

PECOS Provider Enrollment, Chain, and Ownership System

PPACA Patient Protection and Affordable Care Act

RAC recovery audit contractor

ZPIC Zone Program Integrity Contractor

Appendix I: Abbreviations
Related GAO Products

Page 20 GAO-14-712T

Medicare: Further Action Could Improve Improper Payment Prevention 

and Recoupment Efforts. GAO-14-619T. Washington, D.C.: May 20, 

2014.

Medicare Fraud: Progress Made, but More Action Needed to Address 

Medicare Fraud, Waste, and Abuse, GAO-14-560T. Washington, D.C.: 

April 30, 2014.

Medicare: Second Year Update for CMS’s Durable Medical Equipment 

Competitive Bidding Program Round 1 Rebid. GAO-14-156. Washington, 

D.C.: March 7, 2014.

Medicare Program Integrity: Contractors Reported Generating Savings, 

but CMS Could Improve Its Oversight. GAO-14-111. Washington, D.C.: 

October 25, 2013. 

Health Care Fraud and Abuse Control Program: Indicators Provide 

Information on Program Accomplishments, but Assessing Program 

Effectiveness Is Difficult. GAO-13-746. Washington, D.C.: September 30, 

2013.

Medicare Information Technology: Centers for Medicare and Medicaid 

Services Needs to Pursue a Solution for Removing Social Security 

Numbers from Cards. GAO-13-761. Washington, D.C.: September 10, 

2013

Medicare Program Integrity: Few Payments in 2011 Exceeded Limits 

under One Kind of Prepayment Control, but Reassessing Limits Could Be 

Helpful. GAO-13-430. Washington, D.C.: May 9, 2013.

High-Risk Series: An Update. GAO-13-283. Washington, D.C.: 

February 14, 2013. 

Medicare Program Integrity: Greater Prepayment Control Efforts Could 

Increase Savings and Better Ensure Proper Payment. GAO-13-102. 

Washington, D.C.: November 13, 2012.

Medicare Fraud Prevention: CMS Has Implemented a Predictive 

Analytics System, but Needs to Define Measures to Determine Its 

Effectiveness. GAO-13-104. Washington, D.C.: October 15, 2012.

Related GAO Products
Related GAO Products

Page 21 GAO-14-712T

Health Care Fraud: Types of Providers Involved in Medicare, Medicaid, 

and the Children’s Health Insurance Program Cases. GAO-12-820. 

Washington, D.C.: September 7, 2012.

Medicare: CMS Needs an Approach and a Reliable Cost Estimate for 

Removing Social Security Numbers from Medicare Cards. GAO-12-831. 

Washington, D.C.: August 1, 2012.

Program Integrity: Further Action Needed to Address Vulnerabilities in 

Medicaid and Medicare Programs. GAO-12-803T. Washington, D.C.: 

June 7, 2012.

Medicare: Review of the First Year of CMS’s Durable Medical Equipment 

Competitive Bidding Program’s Round 1 Rebid. GAO-12-693. 

Washington, D.C.: May 9, 2012.

Medicare Program Integrity: CMS Continues Efforts to Strengthen the 

Screening of Providers and Suppliers. GAO-12-351. Washington, D.C.: 

April 10, 2012.

Medicare Part D: Instances of Questionable Access to Prescription 

Drugs. GAO-11-699. Washington, D.C.: September 6, 2011.

Medicare Integrity Program: CMS Used Increased Funding for New 

Activities but Could Improve Measurement of Program Effectiveness. 

GAO-11-592. Washington, D.C.: July 29, 2011.

Fraud Detection Systems: Centers for Medicare and Medicaid Services 

Needs to Ensure More Widespread Use. GAO-11-475. Washington, D.C.: 

June 30, 2011.

Medicare Fraud, Waste, and Abuse: Challenges and Strategies for 

Preventing Improper Payments. GAO-10-844T. Washington, D.C.: 

June 15, 2010. 

Medicare Recovery Audit Contracting: Weaknesses Remain in 

Addressing Vulnerabilities to Improper Payments, Although 

Improvements Made to Contractor Oversight. GAO-10-143. Washington, 

D.C.: March 31, 2010. 

Medicare: Thousands of Medicare Providers Abuse the Federal Tax 

System. GAO-08-618. Washington, D.C.: June 13, 2008.
Related GAO Products

Page 22 GAO-14-712T

Medicare: Improvements Needed to Address Improper Payments for 

Medical Equipment and Supplies. GAO-07-59. Washington, D.C.: 

January 31, 2007.

Medicare: More Effective Screening and Stronger Enrollment Standards 

Needed for Medical Equipment Suppliers. GAO-05-656. Washington, 

D.C.: September 22, 2005.

Medicare: CMS’s Program Safeguards Did Not Deter Growth in Spending 

for Power Wheelchairs. GAO-05-43. Washington, D.C.: November 17, 

2004.

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