United States Government Accountability Office

Washington, DC 20548 

March 9, 2006 

Congressional Committees 

Subject: Children’s Health Insurance: Recent HHS-OIG Reviews Inform the 

Congress on Improper Enrollment and Reductions in Low-Income, 

Uninsured Children

The Congress passed legislation creating the State Children’s Health Insurance 

Program (SCHIP) in 1997 to reduce the number of uninsured children in families with 

incomes that are too high to qualify for Medicaid.1

 For SCHIP, the Congress 

appropriated $40 billion over 10 years, with funds allotted annually to the 50 states, 

the District of Columbia,2

 and the U.S. commonwealths and territories. States’ 

participation in SCHIP is voluntary. States that do participate have three options in 

designing their SCHIP programs: expand the Medicaid program to include SCHIPeligible children, develop a separate child health insurance program, or maintain a 

program that combines both of these options. Financed jointly by the states and the 

federal government, SCHIP offers a strong incentive for states to participate by 

offering a higher federal matching rate—that is, the federal government pays a larger 

proportion of program expenditures—than the Medicaid program.3

 While this 

incentive encourages efforts to reduce the number of uninsured children through 

state participation in SCHIP, there have been concerns that states might 

inappropriately enroll Medicaid-eligible children in SCHIP and thus obtain higher 

federal matching funds than allowed under Medicaid. In addition, there has been 

interest in assessing the progress states made to reduce the number of uninsured 

children, including the extent to which states met the objectives and goals 

established in their SCHIP programs.4

 In particular, states must report their progress 

in reducing the number of low-income, uninsured children and may rely on certain 

national data sets, such as the Current Population Survey (CPS), or conduct their 

own surveys, to do so. 

 1

Medicaid is a federal-state program that provides health care coverage to certain categories of lowincome adults and children. SCHIP was established as title XXI of the Social Security Act by the 

Balanced Budget Act of 1997, Pub. L. No. 105-33, § 4901, 111 Stat. 251, 552, and is codified at 42 U.S.C. 

§ 1397aa, et seq. 

2

The District of Columbia is included among our discussion of states for purposes of this report.

3

Federal funds are allotted to states for SCHIP programs up to a specified amount each year. See 42

U.S.C. § 1397dd. 

4

The SCHIP statute includes a provision requiring states, in establishing their programs, to specify 

strategic objectives and performance goals for providing child health assistance. See 42 U.S.C. § 

1397gg. 

 GAO-06-457R Review of HHS OIG’s SCHIP Studies 
In the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 

(BBRA), the Congress directed the Department of Health and Human Services (HHS) 

Office of Inspector General (OIG) to conduct a series of studies on two issues—

determining the number of children who were enrolled in separate SCHIP programs 

but were eligible for Medicaid and assessing states’ progress in reducing the number 

of low-income, uninsured children—every 3 years, beginning in fiscal year 2000.5 

 

This provision required the OIG to only include in its studies states with separate 

SCHIP programs. BBRA directed that we review and report on the OIG’s work. The 

OIG issued its initial reports in February 2001, and our assessment of the OIG’s work 

was published in March 2002.6

 

The OIG’s most recent set of reports on these issues was published in 2004 and 2005.7

 

This report reflects our evaluation of the OIG’s recent reports. Specifically, we 

assessed the OIG’s efforts to inform the Congress on (1) the number of Medicaideligible children enrolled in separate SCHIP programs and (2) states’ progress in 

reducing the number of uninsured children, including the progress they have made in 

meeting the objectives and goals initially established in their SCHIP programs. 

To assess the OIG’s work, we reviewed the OIG’s methodologies and findings. We 

also interviewed the OIG officials who conducted these studies to clarify questions 

and to discuss their response to our prior recommendations.8

 Finally, we examined 

the OIG’s recommendations to the Centers for Medicare & Medicaid Services (CMS), 

which administers SCHIP. Our work was conducted from December 2005 through 

March 2006 in accordance with generally accepted government auditing standards. 

Results in Brief 

The OIG’s most recent set of reports on improper SCHIP enrollment and states’ 

progress in reducing the number of low-income, uninsured children informed the 

Congress about these issues and included improvements from its initial studies. For 

example, in evaluating the number of children who were enrolled in separate SCHIP 

programs but were eligible for Medicaid, the OIG broadened the scope of its initial 

 5

Pub. L. No. 106-113, App. F., § 703, 113 Stat. 1501A-321, 1501A-401-402.

6

GAO, Children’s Health Insurance: Inspector General Reviews Should Be Expanded to Further

Inform the Congress, GAO-02-512 (Washington, D.C.: Mar. 20, 2002). 

7

Department of Health and Human Services Office of Inspector General, SCHIP: States’ Progress in 

Reducing the Number of Uninsured Children (Washington, D.C.: August 2004); Determining if 

Children Enrolled in Separate SCHIPs Were Eligible for Medicaid (Washington, D.C.: June 2005); and 

Determining if Children Classified as SCHIP Medicaid Expansion Meet Eligibility Criteria 

(Washington, D.C.: October 2005).

8

See GAO-02-512. In that report, we noted that the OIG’s findings could not be generalized to all SCHIP 

programs because sample cases were limited to five states’ separate SCHIP programs. Therefore, we

recommended that the OIG (1) expand its scope when conducting subsequent mandated studies and

(2) review enrollment practices in states with Medicaid expansion programs, in addition to separate

SCHIP programs, to further inform the Congress about the appropriateness of enrollment. Because 

state evaluations of reductions in the uninsured had limitations, we also suggested that the OIG review

other available literature on changes in the uninsured population for its next study. 

2 GAO-06-457R Review of HHS OIG’s SCHIP Studies
study to include a random sample of children’s case files from the 34 separate SCHIP 

programs with available data. In its initial study responding to the BBRA mandate, 

the OIG only examined case files from 5 separate SCHIP programs. In its most recent 

report, the OIG estimated that only 1 percent of children were improperly enrolled in 

separate SCHIP programs. The confidence interval the OIG calculated for its 

enrollment error rate, which provides an estimated range of values that is likely to 

include the true error rate, was 0.3 to 2.6 percent. We believe that this confidence 

interval is relatively wide for such an analysis and is likely the result of the small 

sample of case files reviewed by the OIG. However, we recognize that even at its 

upper bound, the enrollment error rate for the population would be 2.6 percent. In 

addition, 7 percent of separate SCHIP case files did not include enough information 

to support enrollment decisions, but the OIG did not find any evidence in these case 

files to indicate that the enrollment decisions were inappropriate. In part to respond 

to our earlier recommendation that the OIG expand its scope beyond the separate 

SCHIP programs, the OIG further informed the Congress about improper SCHIP 

enrollment by conducting an additional study in 29 states with Medicaid expansion 

programs. This study, which also evaluated the enrollment decisions in a random 

sample of case files, identified 7 percent of sampled children as not meeting the state 

eligibility criteria for Medicaid expansion and 10 percent of case files as having

missing documentation. 

Similarly, for its most recent review of states’ progress in reducing the number of 

low-income, uninsured children, the OIG expanded its scope to include the 46 states 

that submitted SCHIP annual reports for fiscal year 2002. In its initial study 

responding to the BBRA mandate, the OIG only examined the annual reports of 

5 states with separate SCHIP programs. The OIG also supplemented its most recent 

review by examining several national data sources on the uninsured. The OIG noted 

that states continue to face challenges in their efforts to measure the change in the 

number of low-income, uninsured children, and only 22 of the 46 states that 

submitted reports directly measured their progress in this area. One of the biggest 

challenges in measuring progress is the limitation in data sources—including the 

often-used CPS, which for various reasons, such as small sample sizes, has not 

produced reliable state-level estimates in the past. In light of these obstacles, the OIG 

recommended that CMS continue to work with states to address concerns about data 

sources used to measure such progress. We concur with this recommendation. In 

addition, absent state submission of data directly measuring changes in low-income, 

uninsurance rates through their SCHIP annual reports, the OIG suggested, and we 

concur, that CMS could itself measure such reductions by completing its own 

analysis of available CPS data, which now include the results of broader state 

samples. 

In commenting on a draft of this report, the OIG did not comment on our findings. 

The OIG provided technical comments, which we incorporated as appropriate. 

3 GAO-06-457R Review of HHS OIG’s SCHIP Studies
Background 

Medicaid and SCHIP, joint federal-state programs to finance health care coverage for 

certain categories of low-income individuals, represent the primary source of health 

insurance coverage for low-income, uninsured children. Although Medicaid has 

provided coverage to children since 1965, SCHIP is a relatively new program,

established in 1997. As of January 2006, 11 states had expanded their Medicaid 

programs to include children eligible for SCHIP, 19 states had separate SCHIP 

programs, and 20 states had combination programs.9,10 (See fig. 1.) 

Figure 1: States’ Design Choices under SCHIP, January 2006 

 9

Prior to September 30, 2002, Tennessee had a Medicaid expansion program under SCHIP, which

covered children born before October 1, 1983, and who were under age 19 with family incomes up to 

100 percent of the federal poverty level. After September 2002, Tennessee discontinued its SCHIP 

program because all enrolled children had aged out of the program. 

10At the time of the OIG’s review, New York had a combination SCHIP program. New York’s program 

changed to a separate SCHIP program as of April 1, 2005, when all of the children enrolled in the

state’s Medicaid expansion aged out of the program.

4 GAO-06-457R Review of HHS OIG’s SCHIP Studies
Medicaid program expenditures are shared between states and the federal 

government, and the share is determined using a formula that is based on a state’s per 

capita income in relation to the national average. Federal matching rates for SCHIP 

are “enhanced”—they are established under a formula that takes 70 percent of a 

state’s Medicaid matching rate and adds 30 percentage points, with an overall federal 

share that may not exceed 85 percent.11 In fiscal year 2006, the enhanced federal 

match rates for SCHIP ranged from 65 to about 83 percent while the federal match 

rates for Medicaid programs ranged from 50 to about 76 percent. 

Under SCHIP, each state is required to submit a SCHIP plan and an annual report, 

which must include a description of the state’s progress in reducing the number of 

low-income, uninsured children. States may rely on the CPS, which is a monthly 

survey of a sample of American households conducted by the Census Bureau and 

collects information on characteristics of the labor force, to report progress in 

reducing the number of low-income, uninsured children.12 In particular months, the 

Census Bureau supplements its survey by incorporating additional questions. For 

example, the March Supplement historically asks respondents about their health 

insurance status and provides the only nationwide source of information on 

uninsured children by state. 

The OIG’s Assessment of Improper 

Enrollment Identified Few Errors 

By broadening the scope of its initial study, the OIG’s most recent set of reports on 

the number of children who were enrolled in separate SCHIP programs but were 

eligible for Medicaid more fully informed the Congress on this issue. In contrast to 

its initial study in which the OIG reviewed case files for five separate SCHIP 

programs, the OIG’s most recent work included a review of a sample of case files 

from all separate SCHIP programs for which data were available. Similar to its initial 

study, the OIG identified only 1 percent of children as being improperly enrolled in 

separate SCHIP programs. The confidence interval the OIG calculated for its 

enrollment error rate is relatively wide; however, even at its upper bound, the error 

rate would be 2.6 percent for the population. The OIG augmented this work by also 

evaluating enrollment decisions in a random sample of case files from 29 Medicaid 

expansion states. 

The OIG’s Assessment of Improper Enrollment 

Broadened to Include Nearly All SCHIP Programs

The OIG broadened the scope of its initial study from a review of 5 separate SCHIP 

programs to a review of the 34 separate SCHIP programs for which data were 

 11For example, a state with a 50 percent Medicaid match receives a 65 percent match under SCHIP. 

12The CPS is the primary source of information on the labor force characteristics of the U.S.

population, and estimates obtained from the CPS include employment, unemployment, earnings, and 

hours of work. 

5 GAO-06-457R Review of HHS OIG’s SCHIP Studies
available.13 From these programs, the OIG selected a random sample of 400 case files 

to assess enrollment decisions. After eliminating cases that did not fit study criteria, 

the OIG ultimately reviewed 386 case files. The OIG reviewed documentation within 

the case files, including the SCHIP application or the most recent eligibility 

redetermination; supporting income documentation; and calculation sheets states 

used to determine family income. The OIG did not verify the accuracy and 

completeness of the state case files; rather, it focused on whether the information in 

each file supported the eligibility determination reached by the state. If case files 

were missing documentation, the OIG determined if the files included any 

information that indicated enrollment decisions were inappropriate. Using the same 

methodology, the OIG also reviewed a random sample of case files in 29 Medicaid 

expansion programs with available data.14 Of the 400 case files randomly selected for 

this study, 357 met study criteria and were reviewed. This additional work was 

undertaken in part to respond to our earlier recommendation that the OIG expand its 

review to include Medicaid expansion programs. The OIG’s review of enrollment 

decisions in both separate SCHIP and Medicaid expansion programs went beyond the 

BBRA mandate and more fully informed the Congress on this issue. 

The OIG’s sample of case files was drawn from over 80 percent of all separate SCHIP 

and Medicaid expansion programs with available data. Nevertheless, our assessment 

is that this sample was small compared to the total SCHIP population, as it 

represented 0.01 percent of total separate SCHIP enrollees and 0.04 percent of 

Medicaid expansion enrollees. The small sample size resulted in a less precise 

estimate of the number of cases of inappropriate SCHIP enrollment. In discussing 

our assessment of the sample size, the OIG emphasized the increased work 

associated with broadening its scope from 5 to 34 separate SCHIP programs and 

reviewing the additional 29 Medicaid expansion programs. The OIG also explained 

that the size of its sample was influenced, in part, by available resources and 

competing priorities. 

The OIG’s Reviews Identified Few Examples

of Inappropriate Enrollment

The OIG’s findings regarding the number of children improperly enrolled in separate 

SCHIP programs paralleled its earlier study on this topic, with only 1 percent of 

children (4 of 386 cases) identified as being inappropriately enrolled. In each of these 

4 cases, the children were eligible for the respective state’s Medicaid program. In its 

Medicaid expansion study, the OIG identified 7 percent of sampled children (24 of 

357 cases) as not meeting the state eligibility criteria for Medicaid expansion. Of 

these cases, 21 had family incomes that were too low to qualify for Medicaid 

expansion, and the remaining 3 had family incomes that were too high to qualify. For 

both separate and expansion programs, enrollment errors were due to a variety of 

reasons, including caseworkers misinterpreting income information, multiplying daily 

 13Two separate SCHIP programs—Michigan and Rhode Island—were unable to provide necessary data 

to the OIG. 

14Michigan’s Medicaid expansion program was unable to provide necessary data to the OIG.

6 GAO-06-457R Review of HHS OIG’s SCHIP Studies
wages by the wrong number of days, or basing a family’s income on weekly as 

opposed to biweekly pay. 

For the separate SCHIP study, the OIG projected its error rate estimate to the

population, and a 95 percent confidence interval was estimated as 0.3 to 2.6 percent.15

 

The confidence interval, which we consider to be relatively wide in light of the 

enrollment error rate of 1 percent, is likely a result of the small sample size.16

 

However, even at its upper bound, the error rate would be 2.6 percent for the 

population. The OIG did not project to the population for Medicaid expansion 

programs because of problems identified with population data provided by certain 

states, such as data that mistakenly included children who were enrolled in states’ 

traditional Medicaid programs. 

In addition to the definitive cases of inappropriate enrollment identified above, the 

OIG noted that some case files—approximately 7 percent of the 386 separate SCHIP 

and 10 percent of the 357 Medicaid expansion case files—did not include complete 

documentation to support enrollment determinations. However, the OIG reviewed 

the documentation included in these case files and did not identify any information 

that indicated enrollment decisions were inappropriate. Further, the OIG explained 

that for the case files with missing documentation, income levels were toward the 

middle of the SCHIP eligibility range, as opposed to near the lower bound of the 

range closer to Medicaid eligibility levels. Therefore, errors in documentation or 

calculations of resources would have needed to be extensive for the children to be 

eligible for traditional Medicaid as opposed to SCHIP. We concurred with the OIG’s 

reasoning. 

The OIG Identified Challenges States Face in 

Determining the Number of Uninsured 

and Opportunities for CMS Assistance 

To assess states’ progress in reducing the number of low-income, uninsured children, 

the OIG also broadened the scope of its mandated review to include all states that 

submitted SCHIP annual reports for fiscal year 2002 by June 1, 2003. The OIG’s 

review of these annual reports indicated that states continue to experience 

challenges when determining their progress in reducing the number of low-income, 

uninsured children, primarily with data sources. We agree with the OIG’s 

recommendation that CMS continue to work with states to address concerns about 

data sources used to measure their progress in reducing the number of low-income, 

uninsured children. 

 15The OIG did not report confidence intervals for its initial review of inappropriate SCHIP enrollment. 

16A confidence interval provides an estimated range of values, within which the true error rate for the 

population will likely fall. For this study, the OIG calculated that the true enrollment error rate could 

be from 0.3 to 2.6 percent, which is 70 percent below and 160 percent above the estimated error rate. 

7 GAO-06-457R Review of HHS OIG’s SCHIP Studies
The OIG’s Review Indicated States’ Efforts to Report Progress 

in Reducing Uninsured Children Are Hindered by Data Limitations

Similar to its most recent work on inappropriate enrollment in SCHIP programs, the 

OIG expanded its review of state efforts to measure changes in the number of lowincome, uninsured children. The OIG reviewed the fiscal year 2002 SCHIP annual 

reports of the 46 states that submitted them by June 1, 2003. In its initial report, the 

OIG reviewed reports from 5 states’ separate SCHIP programs.17 The OIG reviewed 

the annual reports to determine states’ progress in meeting the strategic objective of 

reducing the number of uninsured children. While 22 states used CPS or state survey 

data to demonstrate changes in the uninsured population of children, the remaining 

24 states did not respond directly to the objective.18 Instead, 19 of these 24 states 

used SCHIP enrollment data as a proxy for demonstrating their progress in reducing 

the number of uninsured children. Of the remaining states, 3 provided responses that 

did not measure insurance coverage or enrollment, and 2 did not respond. Further, 

the OIG augmented its assessment of state efforts by also reviewing national data on 

the uninsured—including data from the CPS, the National Health Interview Survey, 

and the Urban Institute. These sources were consistent with the majority of states’ 

annual reports that indicated a reduction in the number of uninsured children. By 

expanding its scope, the OIG went beyond BBRA’s requirements to inform the 

Congress on states’ progress in reducing the population of uninsured children. 

The OIG emphasized, and we acknowledge, that efforts to measure progress in

reducing the number of low-income, uninsured children in states continue to be 

hindered by multiple factors, such as limitations in data sources and the often 

prohibitive cost of conducting state surveys. For example, CPS data used by many 

states have well-established shortcomings—particularly with regard to state-level 

estimates—which can be unreliable and exhibit volatility from year to year because 

of small sample sizes. This is particularly true in states with smaller populations. 

Also, children who are enrolled in Medicaid are often undercounted in CPS data and 

may be mistakenly counted as uninsured. Finally, as noted in the OIG’s recent report, 

the manner in which the Census Bureau asks respondents about their health 

insurance coverage during the past year may lead to respondents incorrectly 

answering the question. As a result, CPS data may overestimate the number of 

uninsured children.19

 17Four of the five states excluded from the most recent OIG review—Connecticut, Hawaii, Minnesota,

and Nevada—were excluded because they did not submit their SCHIP annual reports by June 1, 2003. 

The remaining state, Tennessee, was not required to submit an annual report because there was no 

one enrolled in its SCHIP program.

18Of the 22 states that directly demonstrated changes in the uninsured population of children, 12 states

used CPS data and 10 states used state survey data. 

19Although the CPS asks respondents if they had health insurance coverage within the past year, the 

question is asked at a specific point in time and may result in respondents answering incorrectly. For 

example, those who had health insurance at some time during the year, but who are uninsured at the 

time of the survey, may mistakenly answer the question with their current uninsured status, which can 

lead to an overestimate of the uninsurance rate. 

8 GAO-06-457R Review of HHS OIG’s SCHIP Studies
In addition to data source problems, the OIG noted that some states use changes in 

SCHIP enrollment to demonstrate progress in meeting this objective. However, we 

agree with the OIG that increases in SCHIP enrollment are not a valid measure of 

reductions in the number of low-income, uninsured children. For example, an 

increase in SCHIP enrollment can be the result of children moving from private 

health insurance coverage to public insurance under SCHIP. In addition, declines in 

the economy and increased unemployment can lead to some children losing their 

private health insurance coverage and enrolling in SCHIP, and others becoming 

uninsured because they are ineligible for SCHIP. 

The OIG Suggested CMS Assist States in Future

Efforts to Estimate Uninsured Children

In its most recent report, the OIG recommended, and we agree, that CMS should 

continue to work with states to determine whether ongoing CPS sample size 

improvements have alleviated concerns about limitations in the CPS data. In 1999, 

the Congress appropriated $10 million annually for the Census Bureau for fiscal year 

2000 and subsequent fiscal years to improve the reliability of CPS data for estimating 

the uninsured population of low-income children. Specifically, in response to 

concerns about the reliability of state-level estimates, the Census Bureau increased 

the survey sample size for each state, which may improve the accuracy of CPS 

estimates of low-income, uninsured children.20 Although these improved data were 

available in March 2002, not all states used these data in their fiscal year 2002 SCHIP 

annual reports. Of the 12 states that used CPS data to determine their progress in 

reducing the number of low-income, uninsured children, only 4 used the March 2002 

data in their reports. The remaining 8 states relied on data from prior years. The OIG 

did not explore the reasons why these 8 states did not incorporate the March 2002 

data in their reports. 

Further, CPS data are easily accessible and are available at no cost. Therefore, 

absent state submission of data measuring changes in low-income, uninsurance rates 

through their SCHIP annual reports, the OIG officials suggested, and we concur, that 

CMS could itself measure such reductions by completing its own analysis of CPS 

data. 

Agency Comments 

We received comments on a draft of this report from the HHS-OIG (see the 

enclosure). In commenting on a draft of this report, the OIG did not comment on our 

findings, but the OIG did provide technical comments, which we incorporated as 

appropriate. 

 20When reporting uninsurance rates, the Census Bureau reports 3-year averages. Therefore, at least 

4 years of data will need to be collected to measure the full impact of the expanded sample. The

4 years of data will allow for a comparison of the change in the rate of low-income, uninsured children 

from two consecutive 3-year averages. 

9 GAO-06-457R Review of HHS OIG’s SCHIP Studies
- - - - - 

We are sending a copy of this report to the Inspector General of HHS and other 

interested parties. In addition, the report is also available at no charge on GAO’s Web 

site at http://www.gao.gov. 

If you or your staffs have questions about this report, please contact me at (312) 220-

7600 or aronovitzl@gao.gov. Contact points for our Offices of Congressional 

Relations and Public Affairs may be found on the last page of this report. Susan 

Anthony, Assistant Director; Kevin Milne; Dae Park; and Sari B. Shuman made key 

contributions to this report. 

Leslie G. Aronovitz 

Director, Health Care 

Enclosure 

10 GAO-06-457R Review of HHS OIG’s SCHIP Studies
List of Committees 

The Honorable Arlen Specter 

Chairman 

The Honorable Tom Harkin 

Ranking Minority Member 

Subcommittee on Labor, Health and Human Services, 

 Education, and Related Agencies 

Committee on Appropriations 

United States Senate 

The Honorable Charles E. Grassley 

Chairman 

The Honorable Max Baucus 

Ranking Minority Member 

Committee on Finance

United States Senate 

The Honorable Ralph Regula 

Chairman 

The Honorable David R. Obey 

Ranking Minority Member 

Subcommittee on Labor, Health and Human Services, 

 Education, and Related Agencies 

Committee on Appropriations 

House of Representatives 

The Honorable Joe Barton 

Chairman 

The Honorable John D. Dingell 

Ranking Minority Member 

Committee on Energy and Commerce 

House of Representatives 

11 GAO-06-457R Review of HHS OIG’s SCHIP Studies 
Enclosure 

Comments from the Department of Health and Human Services 

12 GAO-06-457R Review of HHS OIG’s SCHIP Studies 
Enclosure 

(290512)

13 GAO-06-457R Review of HHS OIG’s SCHIP Studies
This is a work of the U.S. government and is not subject to copyright protection in the 

United States. It may be reproduced and distributed in its entirety without further 

permission from GAO. However, because this work may contain copyrighted images or 

other material, permission from the copyright holder may be necessary if you wish to 

reproduce this material separately. 
GAO’s Mission The Government Accountability Office, the audit, evaluation and 

investigative arm of Congress, exists to support Congress in meeting its 

constitutional responsibilities and to help improve the performance and 

accountability of the federal government for the American people. GAO 

examines the use of public funds; evaluates federal programs and policies; 

and provides analyses, recommendations, and other assistance to help

Congress make informed oversight, policy, and funding decisions. GAO’s 

commitment to good government is reflected in its core values of 

accountability, integrity, and reliability. 

The fastest and easiest way to obtain copies of GAO documents at no cost

is through GAO’s Web site (www.gao.gov). Each weekday, GAO posts 

newly released reports, testimony, and correspondence on its Web site. To

have GAO e-mail you a list of newly posted products every afternoon, go 

to www.gao.gov and select “Subscribe to Updates.” 

The first copy of each printed report is free. Additional copies are $2 each. 

A check or money order should be made out to the Superintendent of 

Documents. GAO also accepts VISA and Mastercard. Orders for 100 or 

more copies mailed to a single address are discounted 25 percent. Orders 

should be sent to: 

U.S. Government Accountability Office 

441 G Street NW, Room LM 

Washington, D.C. 20548 

To order by Phone: Voice: (202) 512-6000 

TDD: (202) 512-2537 

Fax: (202) 512-6061 

Contact: 

Web site: www.gao.gov/fraudnet/fraudnet.htm

E-mail: fraudnet@gao.gov

Automated answering system: (800) 424-5454 or (202) 512-7470 

Gloria Jarmon, Managing Director, JarmonG@gao.gov (202) 512-4400 

U.S. Government Accountability Office, 441 G Street NW, Room 7125 

Washington, D.C. 20548 

Paul Anderson, Managing Director, AndersonP1@gao.gov (202) 512-4800

U.S. Government Accountability Office, 441 G Street NW, Room 7149 

Washington, D.C. 20548 

Obtaining Copies of 

GAO Reports and 

Testimony

Order by Mail or Phone 

To Report Fraud,

Waste, and Abuse in 

Federal Programs 

Congressional 

Relations 

Public Affairs 

PRINTED ON RECYCLED PAPER