DEPARTMENT OF 

HEALTH AND HUMAN 

SERVICES

Opportunities for Financial 

Savings and Program 

Improvements in Medicare 

and Medicaid Remain

Statement of James Cosgrove

Director, Health Care

Carolyn L. Yocom

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. EDT

Wednesday, May 9, 2012

GAO-12-719T

United States Government Accountability Office

GAO

Don't have a QR code 

reader? Several are 

available for free online.

To access this report 

electronically, scan this 

QR Code.
United States Government Accountability Office

Highlights of GAO-12-719T, before the 

Subcommittee on Oversight and 

Investigations, Committee on Energy and 

Commerce, House of Representatives

May 9, 2012

DEPARTMENT OF HEALTH AND HUMAN 

SERVICES

Opportunities for Financial Savings and Program 

Improvements in Medicare and Medicaid Remain

Why GAO Did This Study

HHS manages hundreds of complex 

programs benefiting the health and 

well-being of Americans, accounting 

for a quarter of all federal outlays. For 

fiscal year 2012, HHS is responsible 

for approximately $76 billion in 

discretionary spending and for an 

estimated $788 billion in mandatory 

spending. The size and critical mission 

of the two largest HHS programs, 

Medicare and Medicaid, make it 

imperative that HHS is fiscally prudent 

yet vigilant in protecting the 

populations that depend on these 

programs. In recent years, GAO has 

identified shortcomings and 

recommended actions to enhance 

operations and correct inefficiencies in 

Medicare and Medicaid, and HHS has 

implemented many recommendations, 

resulting in billions of dollars in 

savings. Because agencies now must 

do more with less, recommendations 

not yet implemented are opportunities 

for further conserving HHS funds and 

strengthening oversight of programs 

serving the nation’s most vulnerable 

populations. 

GAO was asked to testify on issues 

related to HHS’s budget. This 

statement draws from GAO’s prior 

work, including work on these two 

high-risk programs, in which GAO 

made recommendations related to 

(1) the management of Medicare and 

(2) the need for additional oversight of 

Medicaid. To the extent information 

was available, GAO updated the status 

of these recommendations.

What GAO Found

Over the past several years, GAO has made a number of recommendations to 

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

Department of Health and Human Services (HHS)—to increase savings in 

Medicare fee-for-service and Medicare Advantage (MA), which is a private plan 

alternative to the traditional Medicare fee-for-service program. Open 

recommendations that could yield billions of dollars in savings remain in many 

areas, such as the following:

• Minimizing improper payments and fraud in Medicare. GAO 

recommended that CMS require contractors to automate prepayment 

controls to identify potentially improper claims for medical equipment and 

supplies, expand current regulations to revoke billing privileges for home 

health agencies with improper billing practices, designate authorized 

personnel to evaluate and address vulnerabilities in payment systems, and 

enhance payment safeguards for physicians who use advanced imaging 

services.

• Aligning coverage with clinical recommendations. GAO recommended 

that CMS provide coverage for services recommended by clinical experts, as 

appropriate, given cost-effectiveness and other criteria.

• Better aligning payments to MA plans. To ensure that payments to MA 

plans reflect the health status of beneficiaries, GAO recommended that CMS 

more accurately adjust for differences between MA plans and traditional 

Medicare providers in reporting beneficiary diagnoses. GAO also 

recommended that CMS cancel the MA Quality Bonus Payment 

Demonstration because its design precludes it from yielding meaningful 

results. 

GAO has made recommendations to CMS regarding Medicaid program 

oversight. Open recommendations remain in many areas, such as the following:

• Improving oversight of Medicaid payments. GAO recommended that 

CMS adopt transparency requirements and a strategy to ensure that 

supplemental payments to providers have been reviewed by CMS. These 

supplemental payments are separate from and in addition to those made at 

states’ regular Medicaid rates.

• Ensuring Medicaid demonstrations do not increase federal liability. 

GAO recommended that CMS revise its approval process for demonstrations 

to ensure they are budget neutral, which GAO subsequently referred to 

Congress as a matter for consideration. 

The size of Medicare and Medicaid requires CMS to focus continually on the 

appropriateness of the methodology for payments that these programs make and 

the pre- and postpayment checks that can help ensure that program spending is 

appropriate, overpayment recovery is expedient, and agency practices with 

regard to operations for these programs are efficient. Therefore, GAO urges 

HHS to ensure action is taken on open recommendations to advance its 

performance and accountability.

View GAO-12-719T. For more information, 

contact James Cosgrove at (202) 512-7114 or 

cosgrovej@gao.gov or Carolyn L. Yocom at 

(202) 512-7114 or yocomc@gao.gov.
Page 1 GAO-12-719T

Chairman Stearns, Ranking Member DeGette, and Members of the 

Subcommittee:

We are pleased to be here today to discuss budget considerations at the 

Department of Health and Human Services (HHS). As the federal 

government’s principal agency for protecting the health of Americans and 

providing essential human services, especially for vulnerable populations, 

HHS manages over 300 highly complex programs, which account for 

almost a quarter of all federal outlays. For fiscal year 2012, HHS is 

responsible for approximately $76 billion in discretionary spending and 

approximately $788 billion in outlays of mandatory spending. With this 

funding, HHS provides health care insurance for one in four Americans 

through its two largest programs—Medicare and Medicaid—and 

administers more grant dollars than all other federal agencies combined. 

HHS also funds disease research and prevention, oversees the safety 

and effectiveness of medical products, and helps ensure that the nation is 

prepared to respond to public health emergencies, among other things. 

HHS’s size, diverse programs, and critical mission render its finances 

particularly important as Congress and the administration seek to 

decrease the cost of government while improving its performance and 

accountability.

In recent years, we have examined a broad range of issues, identified 

program design and oversight shortcomings, and made numerous 

recommendations to enhance agency operations. In particular, many of 

these recommendations relate to the Medicare and Medicaid programs—

which are the responsibility of the Centers for Medicare & Medicaid 

Services (CMS), an agency within HHS. HHS has implemented many of 

these recommendations, resulting in billions of dollars of savings. Other 

recommendations have led to program improvements that, while not 

always quantifiable, have nonetheless enhanced the efficiency of agency 

operations. For example, in 2004, we reported on CMS’s management of 

its Medicare Secondary Payer debt, which occurs when Medicare pays 

for services that are subsequently determined to be the financial 

responsibility of another payer.1

 1

GAO, Medicare Secondary Payer: Improvements Needed to Enhance Debt Recovery 

Process,

CMS’s implementation of our 

recommendation that it reduce the number of contractors managing this 

workload resulted in savings of $86 million from 2006 through 2010. More 

GAO-04-783 (Washington, D.C.: Aug. 20, 2004).
Page 2 GAO-12-719T

recently, greater savings have been realized as a result of work on CMS’s 

oversight of states’ Medicaid supplemental payment arrangements.2 In 

2007, we reported on a CMS oversight initiative established in response 

to our work, which increased the agency’s scrutiny of state Medicaid 

financing arrangements and resulted in savings of approximately 

$3.4 billion from fiscal year 2007 through 2012.3

While HHS has successfully implemented many of our recommendations, 

our remarks today will focus on spending for which HHS is responsible in 

the context of recommendations we have made that it has yet to 

implement and that we therefore consider open. Specifically, we will 

concentrate on our recommendations to improve the Medicare and 

Medicaid programs. We have designated both as high-risk programs, in 

part because of their size, complexity, susceptibility to improper 

payments, and the need to improve program management.4

Our testimony today draws on our prior products, issued from January 

2007 through April 2012, including our work on overlap and duplication of 

federal programs that may result in inefficient use of taxpayer funds.

The 

recommendations that we will discuss include those that were recently 

made, those not yet fully implemented, and others for which no actions 

have been taken, although several years have elapsed since they were 

made. These recommendations—some of which could result in financial 

savings—include those that address (1) missed opportunities for savings 

in the management of Medicare and (2) the need for additional oversight 

of Medicaid.

5

 2

Medicaid supplemental payments are payments separate from and in addition to those 

made at states’ regular Medicaid rates.

To 

the extent that information was available, we updated the status of HHS’s 

3

GAO, Medicaid Financing: Federal Oversight Initiative Is Consistent with Medicaid 

Payment Principles but Needs Greater Transparency, GAO-07-214 (Washington, D.C.: 

Mar. 30, 2007).

4

GAO, High-Risk Series: An Update, GAO-11-278 (Washington, D.C.: February 2011).

5

GAO, 2012 Annual Report: Opportunities to Reduce Duplication, Overlap and 

Fragmentation, Achieve Savings, and Enhance Revenue, GAO-12-342SP (Washington, 

D.C.: Feb. 28, 2012); Follow-up on 2011 Report: Status of Actions Taken to Reduce 

Duplication, Overlap, and Fragmentation, Save Tax Dollars, and Enhance Revenue,

GAO-12-453SP (Washington, D.C.: Feb. 28, 2012); and Opportunities to Reduce Potential 

Duplication in Government Programs, Save Tax Dollars, and Enhance Revenue, 

GAO-11-318SP (Washington, D.C.: Mar. 1, 2011).
Page 3 GAO-12-719T

implementation of these recommendations in May 2012. Detailed 

information on the scope and methodology for our prior work can be 

found in the reports that we have cited throughout this testimony. We 

conducted the underlying performance audits in accordance with 

generally accepted government auditing standards. Those standards 

require that we plan and perform the audits 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 statement today.

In the past several years, we have made a number of recommendations 

for CMS to address missed opportunities for savings in the Medicare 

program, which the agency has not fully implemented. These include 

recommendations related to the Medicare fee-for-service (FFS) and 

Medicare Advantage (MA) programs.

Minimizing improper payments and fraud. We have a body of issued 

and ongoing work about improper payments in Medicare. In 2007, we 

reported on program integrity activities conducted by CMS contractors to 

minimize improper payments for medical equipment and supplies.6 We 

recommended that CMS require its contractors to develop automated 

prepayment controls to identify potentially improper claims when billing 

reaches atypical levels. CMS agreed with the recommendation, but has 

not implemented it. The agency has added other prepayment controls to 

flag claims for services that were unlikely to be provided in the normal 

course of medical care. However, implementing our recommendation and 

adding additional prepayment controls could enhance identification of 

improper claims before they are paid to reduce reliance on “pay and 

chase” strategies.7 In 2009, we reported that fraudulent and abusive 

practices in home health agencies, such as overstating the severity of a 

beneficiary’s condition, contributed to Medicare home health spending 

and utilization.8

 6

GAO, Medicare: Improvements Needed to Address Improper Payments for Medical 

Equipment and Supplies,

To strengthen controls on improper payments in home 

GAO-07-59 (Washington, D.C.: Jan. 31, 2007).

7

We have ongoing work updating CMS’s progress in implementing prepayment controls.

8

GAO, Medicare: Improvements Needed to Address Improper Payments in Home Health,

GAO-09-185 (Washington, D.C.: Feb. 27, 2009).

Missed Opportunities 

for Savings in 

Medicare

Medicare Fee-for-Service
Page 4 GAO-12-719T

health agencies, we recommended that CMS amend current regulations 

to expand the types of improper billing practices that are grounds for 

revocation of billing privileges. CMS told us that it has begun to explore its 

authority to expand the types of practices that are grounds for revocation 

of billing rights. We believe that CMS should do so expeditiously.

In 2010, we recommended that CMS designate responsible personnel 

with authority to evaluate and promptly address vulnerabilities identified to 

reduce improper payments.9 CMS concurred with this recommendation 

and has begun to implement this process, but does not yet have written 

policies and procedures for a fully developed corrective action process 

that includes monitoring of actions taken.10 Likewise, we recently testified 

before the Senate Committee on Finance regarding CMS efforts to 

combat Medicare fraud.11

Enhancing payment safeguard mechanisms. In 2008, we reported on 

rapid spending growth for advanced imaging services.

We reiterated our prior recommendation and 

noted that CMS could do more to strengthen provider enrollment 

screening to avoid enrolling those intent on committing fraud, improve 

pre- and postpayment claims review to identify and respond to patterns of 

suspicious billing activity more effectively, and identify and address 

vulnerabilities to reduce the ease with which fraudulent entities can obtain 

improper payments.

12

 9

GAO, Medicare Recovery Audit Contracting: Weaknesses Remain in Addressing 

Vulnerabilities to Improper Payments, Although Improvements Made to Contractor 

Oversight, 

We 

recommended that CMS examine the feasibility of adding front-end 

approaches, such as prior authorization, to improve payment safeguard 

mechanisms. CMS has not implemented our recommendation, but is 

currently engaged in a demonstration project to assess the 

appropriateness of physicians’ use of advanced diagnostic imaging 

services furnished to Medicare beneficiaries.

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

10We have ongoing work updating CMS’s progress in implementing these 

recommendations.

11GAO, Medicare: Important Steps Have Been Taken, but More Could Be Done to Deter 

Fraud, GAO-12-671T (Washington, D.C.: Apr. 24, 2012).

12GAO, Medicare Part B Imaging Services: Rapid Spending Growth and Shift to 

Physician Offices Indicate Need for CMS to Consider Additional Management Practices, 

GAO-08-452 (Washington, D.C.: June 13, 2008). 
Page 5 GAO-12-719T

Aligning coverage for services with clinical recommendations. We 

reported in early 2012 that Medicare beneficiaries’ use of preventive

services did not always align with the U.S. Preventive Services Task 

Force’s recommendations.13 We concluded that opportunities exist to 

improve the appropriate use of preventive services through means such 

as revising coverage and cost-sharing policies and educating 

beneficiaries and physicians. In the case of osteoporosis screening, for 

instance, Medicare coverage rules may preclude utilization of the 

recommended screening by all those for whom the service is 

recommended. Conversely, given that the Task Force recommended 

against prostate cancer screening for men aged 75 or older, the absence 

of cost sharing for that population may encourage inappropriate use of 

this service. To better align preventive service use with clinical 

recommendations, we recommended that CMS provide coverage for 

Task Force recommended services, as appropriate, given costeffectiveness and other criteria. In response to our recommendation, the 

agency stated that it had recently used its authority to expand benefits to 

cover several new preventive services. This additional coverage, 

however, does not address the misalignment that remains between 

Medicare coverage for certain services and the corresponding Task Force 

recommendations. We also offered a matter for congressional 

consideration. We suggested that Congress consider requiring 

beneficiaries to share the cost of the services if they receive services the 

Task Force recommends against.

Better reflecting beneficiary health status in payments to MA plans. 

In 2010, the federal government spent about $115 billion on the MA 

program, a private plan alternative to the Medicare FFS program. In 

January 2012, we reported that CMS could achieve billions of dollars in 

additional savings by more accurately adjusting for differences between 

MA plans and Medicare FFS providers in the reporting of beneficiary 

diagnoses.14

 13GAO, Medicare: Use of Preventive Services Could Be Better Aligned with Clinical 

Recommendations, 

CMS uses this diagnosis data and other information to 

construct a risk score for each beneficiary. Higher risk scores result in 

GAO-12-81 (Washington, D.C.: Jan. 18, 2012).

14GAO, Medicare Advantage: CMS Should Improve the Accuracy of Risk Score 

Adjustments for Diagnostic Coding Practices, GAO-12-51 (Washington, D.C.: Jan 12, 

2012).

Medicare Advantage
Page 6 GAO-12-719T

increased Medicare payments to plans, while lower risk scores result in 

reduced Medicare payments to plans. Risk scores should be the same 

among all beneficiaries with the same medical conditions and 

demographic characteristics, regardless of whether they are in MA or 

Medicare FFS. MA plans have an incentive to code diagnoses more 

comprehensively because doing so affects plan payments, which is not 

the case in Medicare FFS. CMS is required by law to make an adjustment 

to MA risk scores to bring them in line with those of Medicare FFS. In this 

report, we found that CMS’s adjustment for diagnostic coding differences 

was too small. We estimated that MA beneficiary risk scores in 2010 were 

from 4.8 to 7.1 percent higher than they likely would have been if they 

had been enrolled in FFS, while CMS’s adjustment for diagnostic coding 

differences was only 3.4 percent. Compared to CMS’s analysis, our 

analysis incorporated more recent beneficiary data and accounted for 

additional beneficiary characteristics that affect risk scores, such as 

health status and sex. A revised methodology that incorporated this 

information could have saved Medicare between $1.2 billion and 

$3.1 billion in 2010 in addition to the $2.7 billion in savings from the 

adjustment CMS made. We expect that savings in 2011 and future years 

would be even greater. CMS has continued to use its 2010 adjustment 

method for 2011 and 2012, even though both we and CMS noted an 

upward trend in the impact of coding differences over time. To improve 

the accuracy of the adjustment made for differences in coding practices 

over time, we recommended that the Secretary of HHS direct the 

Administrator of CMS to incorporate the most recent data available in its 

estimates; identify and account for all years of diagnostic coding 

differences that could affect the payment year for which any adjustment is 

made; account for the upward trend of the annual impact of coding 

differences in its estimates; and to the extent possible, account for all 

relevant differences in beneficiary characteristics between the MA and 

Medicare FFS populations. CMS stated that it found our findings 

informative, but did not comment on our recommendations.

Canceling the MA Quality Bonus Payment Demonstration. We 

recently reported that CMS could achieve billions of dollars in savings by

canceling the MA Quality Bonus Payment Demonstration—which CMS’s 

Office of the Actuary has estimated will cost more than $8 billion over 
Page 7 GAO-12-719T

10 years.15 Rather than implement the quality bonus payments prescribed 

in the 2010 Patient Protection and Affordable Care Act (PPACA), as 

amended, CMS is conducting a nationwide demonstration to test whether 

a scaled bonus structure would lead to larger and faster annual quality 

improvement for MA plans at various performance levels. Compared with 

PPACA’s quality bonus payment system, the demonstration extends the 

bonuses to average-performing plans, accelerates the phase-in of the 

bonuses for plans with above-average performance, and increases the 

size of the bonuses in 2012 and 2013. We found that the demonstration’s 

estimated $8.35 billion cost offsets more than one-third of PPACA’s MA 

payment reductions during its 3-year time frame and that most of the 

additional spending will go to average-performing plans rather than to 

high-performing plans. The MA Quality Bonus Payment Demonstration 

dwarfs all other Medicare demonstrations—both mandatory and 

discretionary—conducted since 1995 in its estimated budgetary impact. It 

is at least seven times larger than that of any other Medicare 

demonstration conducted since 1995 and is greater than the combined 

budgetary impact of all those demonstrations. For a variety of reasons,

the design of the demonstration precludes a credible evaluation of its 

effectiveness in achieving CMS’s stated research goal. We therefore 

believe that it is unlikely that the demonstration will produce meaningful 

results. Accordingly, we recommended that the Secretary of HHS cancel 

the demonstration and allow the MA quality bonus payment system 

established by PPACA to take effect. HHS did not concur with our 

recommendation, stating that it believed the demonstration supports a 

strategy to improve the delivery of health care services, patient health 

outcomes, and population health.

We have conducted a substantial body of work on Medicaid program 

management. Our recommendations have involved a variety of topics and 

have included different aspects of payment arrangements with states.16

 15GAO, Medicare Advantage: Quality Bonus Payment Demonstration Undermined by High 

Estimated Costs and Design Shortcomings, GAO-12-409R (Washington, D.C.: Mar. 21, 

2012).

16We recently testified about CMS’s oversight of Medicaid program integrity. See GAO, 

Medicaid: Federal Oversight of Payments and Program Integrity Needs Improvement, 

GAO-12-674T (Washington, D.C.: Apr. 25, 2012). We also have ongoing work in this area.

Need for Additional 

Oversight of Medicaid
Page 8 GAO-12-719T

Improving oversight of supplemental payments. We have reported on 

varied financing arrangements involving supplemental payments—

disproportionate share hospital (DSH) payments that states are required 

to make to certain hospitals and other non-DSH supplemental 

payments—that increase federal funding without a commensurate 

increase in state funding.17

Ensuring Medicaid demonstrations do not increase federal liability. 

HHS has authority to waive certain statutory provisions to allow states to 

implement Medicaid demonstrations that are likely to assist in achieving 

program objectives. By policy, these demonstrations should not increase 

federal costs. However, we reported in 2008 that HHS had approved two 

state Medicaid demonstrations that could increase the federal financial 

liability substantially.

Our work has found that while a variety of 

federal legislative and CMS actions have helped curb inappropriate 

financing arrangements, gaps in oversight remain. For example, while 

there are federal requirements designed to improve transparency and 

accountability for state DSH payments, similar requirements are not in 

place for non-DSH supplemental payments, which may be increasing. 

From 2006 to 2010, state-reported non-DSH supplemental payments 

increased from 

$6.3 billion to $14 billion; however, according to CMS officials, reporting 

was likely incomplete. We made numerous recommendations aimed at 

improving oversight of supplemental payments. We have recommended 

that CMS adopt transparency requirements for non-DSH supplemental 

payments and develop a strategy to ensure that all state supplemental 

payment arrangements have been reviewed by CMS. CMS has taken 

action to address some of these recommendations, but we continue to 

believe additional action is warranted. CMS has raised concern that 

congressional action may be necessary to fully address our 

recommendations.

18

 17GAO, Medicaid: CMS Needs More Information on the Billions of Dollars Spent on 

Supplemental Payments,

This report followed earlier work that had identified 

similar concerns with HHS approvals of state Medicaid demonstrations 

that were not budget neutral. At the time of our work in 2007, HHS 

disagreed with our recommendation to improve the demonstration review 

GAO-08-614 (Washington D.C.: May 30, 2008) and GAO, 

Medicaid: Ongoing Federal Oversight of Payments to Offset Uncompensated Hospital 

Care Costs Is Warranted, GAO-10-69 (Washington D.C.: Nov. 20, 2009).

18GAO, Medicaid Demonstration Waivers: Recent HHS Approvals Continue to Raise Cost 

and Oversight Concerns, GAO-08-87 (Washington, D.C.: Jan. 31, 2008).
Page 9 GAO-12-719T

process through steps such as clarifying the criteria for reviewing and 

approving states’ proposed spending limits and ensuring that valid 

methods were used to demonstrate budget neutrality. Consequently, we 

referred this to Congress for consideration. HHS subsequently reported 

taking steps, such as monitoring the budget neutrality of ongoing 

demonstrations, to improve its oversight. However, no changes are 

planned in the methods used to determine budget neutrality of 

demonstrations to ensure that demonstrations do not increase the federal 

financial liability.

Improving rate-setting methodologies. In August 2010, we reported 

that CMS had not ensured that all states were complying with federal 

Medicaid requirements that managed care rates be developed in 

accordance with actuarial principles, appropriate for the population and 

services, and certified by actuaries.19

 19GAO, Medicaid Managed Care: CMS’s Oversight of States’ Rate Setting Needs 

Improvement,

For example, we found significant 

gaps in CMS’s oversight of 2 of the 26 states reviewed—CMS had not 

reviewed one state’s rate setting in multiple years and had not completed 

a full review of another state’s rate setting since the actuarial soundness 

requirements became effective in August 2002. Variation in practices 

across CMS regional offices contributed to these gaps and other 

inconsistencies in the agency’s oversight of states’ rate setting. This work 

also found that CMS’s efforts to ensure the quality of the data used to set 

rates were generally limited to requiring assurances from states and 

health plans—efforts that did not provide the agency with enough 

information to ensure the quality of the data used. With limited information 

on data quality, CMS cannot ensure that states’ managed care rates are 

appropriate, which places billions of federal and state dollars at risk for 

misspending. We made recommendations to improve CMS’s oversight of 

states by implementing a mechanism to track state compliance with 

Medicaid managed care actuarial soundness requirements, clarifying 

guidance on rate-setting reviews, and making use of information on data 

quality in overseeing states’ rate setting. HHS agreed with these 

recommendations, and as of May 2012, CMS officials indicated that they 

were reviewing and updating the agency’s guidance and exploring the 

incorporation of information about data quality into its review and approval 

of Medicaid managed care rates.

GAO-10-810 (Washington, D.C.: Aug. 4, 2010).
Page 10 GAO-12-719T

Improved financial stewardship of federal programs is becoming 

increasingly important as the pressure to reduce spending mounts. In an 

agency as large as HHS, the need for vigilance in continuously seeking 

out cost savings cannot be overstated. In our work, we have examined 

many aspects of HHS operations and made recommendations to help 

HHS prevent unnecessary spending, save money, recover funds that 

should rightfully be returned, improve the efficiency of agency operations, 

and improve service for beneficiaries. HHS has implemented many of our 

recommendations that have proven to be financially beneficial while also 

enhancing program management. However, there are still

recommendations we have made that remain open. While we recognize 

that some of the recommendations we have highlighted today are 

relatively new, others are several years old. HHS has made clear that it is 

committed to improving the nation’s health and well-being while 

simultaneously contributing to deficit reduction. We therefore urge HHS to 

expedite action on our open recommendations to further advance its 

performance and accountability.

Chairman Stearns, Ranking Member DeGette, and Members of the 

Subcommittee, this completes our prepared statement. We would be 

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

If you or your staff have any questions about this testimony, please 

contact us at (202) 512-7114 or cosgrovej@gao.gov and 

yocomc@gao.gov. Contact points for our Offices of Congressional 

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

statement. GAO staff who made key contributions to this testimony are 

listed in appendix I.

Concluding 

Observations

GAO Contacts and 

Staff 

Acknowledgments
Appendix I: GAO Contacts and Staff 

Acknowledgments

Page 11 GAO-12-719T

James Cosgrove, (202) 512-7114 or cosgrovej@gao.gov

Carolyn L. Yocom, (202) 512-7114 or yocomc@gao.gov

In addition to the contacts named above, Geri Redican-Bigott, Assistant 

Director; Kelly DeMots; Helen Desaulniers; David Grossman; Elizabeth T. 

Morrison; and Kate Nast made key contributions to this statement.

Appendix I: GAO Contacts and Staff 

Acknowledgments

GAO Contacts

Staff 

Acknowledgments

(291047)
This is a work of the U.S. government and is not subject to copyright protection in the 

United States. The published product 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.
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 website (www.gao.gov). Each weekday afternoon, 

GAO posts on its website newly released reports, testimony, and

correspondence. To have GAO e-mail you a list of newly posted products, 

go to www.gao.gov and select “E-mail Updates.”

The price of each GAO publication reflects GAO’s actual cost of 

production and distribution and depends on the number of pages in the 

publication and whether the publication is printed in color or black and 

white. Pricing and ordering information is posted on GAO’s website, 

http://www.gao.gov/ordering.htm. 

Place orders by calling (202) 512-6000, toll free (866) 801-7077, or 

TDD (202) 512-2537.

Orders may be paid for using American Express, Discover Card, 

MasterCard, Visa, check, or money order. Call for additional information.

Connect with GAO on Facebook, Flickr, Twitter, and YouTube.

Subscribe to our RSS Feeds or E-mail Updates. Listen to our Podcasts.

Visit GAO on the web at www.gao.gov.

Contact:

Website: www.gao.gov/fraudnet/fraudnet.htm

E-mail: fraudnet@gao.gov

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

Katherine Siggerud, Managing Director, siggerudk@gao.gov, (202) 512-

4400, U.S. Government Accountability Office, 441 G Street NW, Room 

7125, Washington, DC 20548

Chuck Young, Managing Director, youngc1@gao.gov, (202) 512-4800

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

Washington, DC 20548

GAO’s Mission

Obtaining Copies of 

GAO Reports and 

Testimony

Order by Phone

Connect with GAO

To Report Fraud, 

Waste, and Abuse in 

Federal Programs

Congressional 

Relations

Public Affairs

Please Print on Recycled Paper.