United States Government Accountability Office

GAO Testimony 

Before the Subcommittee on Health, 

Committee on Ways and Means, House of 

Representatives

MEDICARE PART B 

DRUGS 

CMS Data Source for 

Setting Payments Is 

Practical but Concerns 

Remain 

Statement of A. Bruce Steinwald 

Director, Health Care 

For Release on Delivery

Expected at 1:00 p.m. EDT

Thursday, July 13, 2006

 

GAO-06-971T 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

July 13, 2006

MEDICARE PART B DRUGS 

CMS Data Source for Setting Payments Is 

Highlights of GAO-06-971T, a testimony Practical but Concerns Remain 

before the Subcommittee on Health, 

Committee on Ways and Means, House of 

Representatives 

In 2005, the Centers for Medicare &

Medicaid Services (CMS), as

required by law, began paying for 

physician-administered Part B 

drugs using information on the

drugs’ average sales price (ASP). 

Subsequently, CMS selected ASP as 

the basis to pay for a subset of 

Part B drugs provided at hospital

outpatient departments. To

calculate ASP, CMS uses price data

submitted quarterly by

manufacturers. GAO was asked to

discuss its work on Medicare 

payment rates for Part B drugs.

This testimony is based on several 

GAO products: 

• Medicare Hospital 

Pharmaceuticals: Survey 

Shows Price Variation and 

Highlights Data Collection 

Lessons and Outpatient RateSetting Challenges for CMS, 

GAO-06-372, Apr. 28, 2006.

• Medicare: Comments on CMS 

Proposed 2006 Rates for 

Specified Covered Outpatient 

Drugs and 

Radiopharmaceuticals Used 

in Hospitals, GAO-06-17R,

Oct. 31, 2005. 

• Medicare: Payments for 

Covered Outpatient Drugs 

Exceed Providers’ Costs, 

GAO-01-1118, Sept. 21, 2001. 

Specifically, GAO’s statement 

discusses (1) ASP as a practical 

and timely data source for use in

setting Medicare Part B drug

payment rates and (2) components 

of ASP that are currently unknown 

and implications for Medicare ratesetting. 

In summary, using an ASP-based method to set payment rates for Part B 

drugs is a practical approach compared with methods based on alternative 

data sources, for several reasons. First, ASP is based on actual transactions 

and is a better proxy for providers’ acquisition costs than average wholesale 

price or providers’ charges included on claims for payment, neither of which 

is based on transaction data. Second, ASPs, which manufacturers update 

quarterly, offer information that is relatively timely for rate-setting purposes. 

In comparison, rates for other Medicare payment systems are based on data 

that may be at least 2 years old. Finally, using manufacturers as the data 

source for prices is preferable to collecting such data from health care 

providers, as the manufacturers have data systems in place to track prices, 

whereas health care providers generally do not have systems designed for 

that purpose. 

CMS lacks certain information about the composition of ASP that prompted 

GAO, in commenting on CMS’s 2006 proposed payment rates for a subset of 

Part B drugs, to call ASP “a black box.” Significantly, CMS lacks sufficient 

information on how manufacturers allocate rebates to individual drugs sold 

in combination with other drugs or other products; this is important, as CMS 

does not have the detail it needs to validate the reasonableness of the data 

underlying the reported prices. In addition, CMS does not instruct 

manufacturers to provide a breakdown of price and volume data by 

purchaser type—that is, by physicians, hospitals, other health providers, and 

wholesalers, which purchase drugs for resale to health care providers. As a 

result, CMS cannot determine how well average price data represent 

acquisition costs for different purchaser types. In particular, to the extent 

that some of the sales are to wholesalers that subsequently mark up the 

manufacturer’s price in their sales to providers, the ASP’s representation of 

providers’ acquisition costs is weakened. Additionally, a sufficient empirical 

foundation does not exist for setting the payment rate for Medicare Part B 

drugs at 6 percent above ASP, further complicating efforts to determine the 

appropriateness of the rate. Given these information gaps, CMS is not wellpositioned to validate the accuracy or appropriateness of its ASP-based 

payment rates.

www.gao.gov/cgi-bin/getrpt?GAO-06-971T.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact A. Bruce 

Steinwald at (202) 512-7101 or 

steinwalda@gao.gov. 
Madam Chairman and Members of the Subcommittee: 

I am pleased to be here as you discuss Medicare’s method of paying for 

outpatient drugs covered under the program’s Part B, the part of Medicare 

that covers a broad range of medical services, including physician, 

laboratory, and hospital outpatient department (HOPD) services and 

durable medical equipment (DME). Part B-covered drugs are typically

administered by a physician or other medical professional rather than by

patients themselves. In contrast, drugs covered under the new prescription 

drug benefit, known as Part D, are generally self-administered by patients.

1

In 2005, Medicare paid more than $9 billion for Part B drugs furnished in 

conjunction with physician services, HOPD services, dialysis services, and 

services performed using DME, such as nebulizers.2, 3

Until 2005, Medicare’s method of paying physicians for Part B drugs was 

based on the drug’s average wholesale price (AWP), which, despite its 

name, was neither an average nor what wholesalers charged.4

 It was a 

price that manufacturers derived using their own criteria; there were no 

requirements or conventions that AWP reflect the price of an actual sale of 

drugs by a manufacturer.5

 An analysis we conducted in 2001 on Part B 

drug prices found that Medicare’s AWP-based payments often far 

exceeded market prices that were widely available to health care 

providers.6

The Medicare Prescription Drug, Improvement, and Modernization Act of 

2003 (MMA) mandated that, beginning in 2005, payments for physicianadministered drugs be based on the drug’s average sales price (ASP)—that 

 1

Medicare Part A covers inpatient hospital services; Medicare Part C, known as Medicare 

Advantage, covers beneficiaries enrolled in managed care plans. 

2

In this testimony, we will refer to physicians, hospital outpatient services, dialysis 

services, and durable medical equipment suppliers collectively as providers. 

3

A nebulizer is a device driven by a compressed air machine. It allows the patient to inhale 

medicine in the form of a mist.

4

Until 2004, Medicare paid physicians 95 percent of AWP. Legislation changed Medicare’s 

payment to 85 percent of AWP in 2004. 

5

Manufacturers reported AWPs to organizations that published them in drug price 

compendia, and the Medicare claims administration contractors that pay claims for Part B

drugs based physicians’ payments on the published AWPs. 

6

GAO, Medicare: Payments for Covered Outpatient Drugs Exceed Providers’ Costs, 

GAO-01-1118 (Washington, D.C.: Sept. 21, 2001). 

Page 1 GAO-06-971T
is, an average, calculated from price and volume data reported by drug 

manufacturers, of sales to all U.S. purchasers.7

 The law directed that ASPs 

be net of rebates and other price concessions and that 2005 payments to 

physicians for these drugs be set at 106 percent of ASP.8

The MMA took a different approach to setting rates for a subset of 

Medicare Part B drugs delivered in the HOPD setting. Prior to the MMA, 

Medicare paid HOPDs for Part B drugs based on hospitals’ 1996 median 

costs for these drugs. In response to concerns that payments would not 

reflect the cost of newly introduced pharmaceutical products—such as 

those used to treat cancer or rare blood disorders—1999 legislation 

authorized augmented payments for these drugs on a temporary basis.9

Subsequently, the MMA defined a new payment category for these drugs 

called specified covered outpatient drugs (SCOD). The MMA required the 

Centers for Medicare & Medicaid Services (CMS) in the Department of 

Health and Human Services (HHS) to set rates for this subset of Part B 

drugs. Specifically, it directed CMS to set 2006 payment rates for SCOD 

products equal to hospitals’ average acquisition costs—the cost to 

hospitals of acquiring a product, net of rebates. Subsequently, CMS 

selected ASP as the basis to pay for SCODs provided at HOPDs. 

In several related requirements, the MMA directed us to provide 

information on SCOD costs and CMS’s proposed rates. Among them was a 

requirement to conduct a survey of a large sample of hospitals to obtain 

data on their acquisition costs for SCODs and provide information based 

on these data to the Secretary of Health and Human Services for his 

consideration in setting 2006 Medicare payment rates.10 We were also 

required to evaluate CMS’s proposed rates for SCODs, comment on their 

 7

Certain prices were excluded, including prices paid to federal purchasers and prices for

drugs furnished under the Part D program. 

8

The term rebates refers to price concessions given to purchasers by manufacturers

subsequent to receipt of the product.

9

See the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, Pub. L.

No. 106-113, app. F, § 201 (b), 113 Stat. 1501A-321, 1501A-337—1501A-339. 

10We provided information from this survey in two reports—one on drugs and another on

radiopharmaceuticals. See GAO, Medicare: Drug Purchase Prices for CMS Consideration

in Hospital Outpatient Rate Setting, GAO-05-581R (Washington, D.C.: June 30, 2005), and 

GAO, Medicare: Radiopharmaceutical Purchase Prices for CMS Consideration in 

Hospital Outpatient Rate Setting, GAO-05-733R (Washington, D.C.: July 14, 2005). The

Secretary of HHS considered the price data we provided but elected not to use these data 

as the basis for 2006 rates. 

Page 2 GAO-06-971T
appropriateness in light of the survey we conducted, and advise on future 

data collection efforts by CMS based on our survey experience.

11 We 

issued reports in 2005 and 2006 in response to these requirements, and my 

remarks about ASP are based on that work. Specifically, my remarks today 

will focus on (1) ASP as a practical and timely data source for use in 

setting Medicare Part B drug payment rates and (2) components of ASP 

that are currently unknown and implications for Medicare rate-setting. Our 

work was conducted in accordance with generally accepted government 

auditing standards. 

In summary, using an ASP-based method to set payment rates for Part B 

drugs is a practical approach compared with methods based on alternative 

data sources, for several reasons. First, ASP is based on actual 

transactions and is a better proxy for health care providers’ acquisition 

costs than AWP or health care providers’ charges included on claims for 

payment, neither of which is based on transaction data. Second, ASPs, 

which manufacturers update quarterly, offer information that is relatively 

timely for rate-setting purposes. In comparison, rates for other Medicare 

payment systems are based on data that may be at least 2 years old. 

Finally, using manufacturers as the data source for prices is preferable to

collecting such data from health care providers, as the manufacturers have

data systems in place to track prices, whereas health care providers 

generally do not have systems designed for that purpose. 

Despite these advantages, CMS lacks certain information about the 

composition of ASP that prompted us, in our report commenting on CMS’s 

proposed 2006 SCOD rates, to call ASP “a black box.”12 Significantly, CMS 

lacks sufficient information on how manufacturers allocate rebates to 

individual drugs sold in combination with other drugs or other products; 

this is important, as CMS does not have the detail it needs to validate the 

reasonableness of the data underlying the reported prices. In addition, 

CMS does not instruct manufacturers to provide a breakdown of price and 

volume data by purchaser type—that is, by physicians, hospitals, other 

health care providers, and wholesalers, which purchase drugs for resale to 

 11We provided our comments on the proposed rates in GAO, Medicare: Comments on CMS

Proposed 2006 Rates for Specified Covered Outpatient Drugs and Radiopharmaceuticals 

Used in Hospitals, GAO-06-17R (Washington, D.C.: Oct. 31, 2005). We provided information 

on our data collection experience in GAO, Medicare Hospital Pharmaceuticals: Survey

Shows Price Variation and Highlights Data Collection Lessons and Outpatient RateSetting Challenges for CMS, GAO-06-372 (Washington, D.C.: Apr. 28, 2006).

12GAO-06-17R. 

Page 3 GAO-06-971T
health care providers. As a result, CMS cannot determine how well 

average price data represent acquisition costs for different purchaser 

types. In particular, to the extent that some of the sales are to wholesalers 

that may subsequently mark up the manufacturer’s price in their sales to 

health care providers, the ASP’s representation of providers’ acquisition 

costs is weakened. Additionally, a sufficient empirical foundation does not 

exist for setting the payment rate for Medicare Part B drugs at 6 percent 

above ASP, further complicating efforts to determine the appropriateness 

of the rate. Given these information gaps, CMS is not well-positioned to 

validate the accuracy or appropriateness of its ASP-based payment rates. 

CMS calculates payment rates for each Part B drug with information on 

price data that manufacturers report quarterly to the agency. In reporting 

their price data to CMS, manufacturers are required to account for price 

concessions, such as discounts and rebates, which can affect the amount 

health care providers actually pay for a drug. 

The MMA defined ASP as the average sales price for all U.S. purchasers of 

a drug, net of volume, prompt pay, and cash discounts; charge-backs and

rebates. Certain prices, including prices paid by federal purchasers, are 

excluded, as are prices for drugs furnished under Medicare Part D. CMS 

instructs pharmaceutical manufacturers to report data to CMS—within 

30 days after the end of each quarter—on the average sale price for each 

Part B drug sold by the manufacturer. For drugs sold at different strengths 

and package sizes, manufacturers are required to report price and volume 

data for each product, after accounting for price concessions. CMS then 

aggregates the manufacturer-reported ASPs to calculate a national ASP for 

each drug category.13

Background 

ASP Is a Price Measure 

Established in Law and 

Calculated with 

Manufacturers’ Data 

Varying Payment 

Arrangements Affect the 

Price Purchasers Pay at 

the Time of Sale 

Common drug purchasing arrangements can substantially affect the 

amount health care providers actually pay for a drug. Physicians and 

hospitals may belong to group purchasing organizations (GPO) that 

negotiate prices with wholesalers or manufacturers on behalf of GPO 

members. GPOs may negotiate different prices for different purchasers, 

 13Manufacturers’ reported price data are based on the Food and Drug Administration’s 

(FDA) system of National Drug Codes, while the ASP that CMS calculates for each drug is 

based on the agency’s Healthcare Common Procedure Coding System, which uses

categories that are broader than the FDA’s coding system. 

Page 4 GAO-06-971T
such as physicians, suppliers of DME, or hospitals. In addition, health care 

providers can purchase covered outpatient drugs from general or specialty

pharmaceutical wholesalers or can have direct purchase agreements with 

manufacturers. In these arrangements, providers may benefit from 

discounts, rebates, and charge-backs that reduce the actual costs 

providers incur. Discounts are applied at the time of purchase, while 

rebates are paid by manufacturers some time after the purchase. Rebates

may be based on the number of several different products purchased over 

an extended period of time. Under a charge-back arrangement, the 

provider negotiates a price with the manufacturer that is lower than the 

price the wholesaler normally charges for the product, and the provider 

pays the wholesaler the negotiated price. The manufacturer then pays the

wholesaler the difference between the wholesale price and the price 

negotiated between the manufacturer and the provider. 

Using an ASP-based method to set prices for Medicare Part B drugs is a 

practical approach compared with alternative data sources for several 

reasons. First, unlike AWP, ASP is based on actual transactions, making it 

a useful proxy for health care providers’ acquisition costs. Whereas AWPs 

were list prices developed by manufacturers and not required to be related 

to market prices that health care providers paid for products, ASPs are 

based on actual sales to purchasers. For similar reasons, payments based 

on ASPs are preferable to those based on providers’ charges, as charges 

are made up of costs and mark-ups, and mark-ups vary widely across 

providers, making estimates of the average costs of drugs across all 

providers wide-ranging and insufficiently precise. In addition, basing 

payments on charges does not offer any incentives for health care 

providers to minimize their acquisition costs. 

ASP Is a Practical 

Payment Approach, 

Given the Limitations 

of Other Data Sources 

Available for RateSetting 

Second, ASPs offer relatively timely information for rate-setting purposes. 

Manufacturers have 30 days following the completion of each quarter to 

report new price data to CMS. Before the end of the quarter in which 

manufacturers report prices, CMS posts the updated Part B drug payment

rates, to take effect the first day of the next quarter. Thus, the rates set are 

based on data from manufacturers that are, on average, about 6 months 

old. In comparison, rates for other Medicare payment systems are based 

on data that may be at least 2 years old. 

Third, acquiring price data from manufacturers is preferable to surveying 

health care providers, as the manufacturers have data systems in place 

that track prices, whereas the latter generally do not have systems 

designed for that purpose. In our survey of 1,157 hospitals, we found that 

Page 5 GAO-06-971T
providing data on drug acquisition costs made substantial demands on 

hospitals’ information systems and staff. In some cases, hospitals had to 

collect the data manually, provide us with copies of paper invoices, or 

develop new data processing to retrieve the detailed price data needed 

from their automated information systems.14 Hospital officials told us that, 

to submit the required price data, they had to divert staff from their normal 

duties, thereby incurring additional staff and contractor costs. Officials 

told us their data collection difficulties were particularly pronounced 

regarding information on manufacturers’ rebates, which affect a drug’s net 

acquisition cost.15 In addition, we incurred considerable costs as data 

collectors, signaling the difficulties that CMS would face should it 

implement similar surveys of hospitals in the future. 

Despite its practicality as a data source, ASP remains a “black box.” That 

is, CMS lacks detailed information about the components of 

manufacturers’ reported price data—namely, methods manufacturers use 

to allocate rebates to individual drugs and the sales prices paid by type of 

purchaser. Furthermore, for all but SCODs provided in the HOPD setting, 

no empirical support exists for setting rates at 6 percent above ASP, and 

questions remain about setting SCOD payment rates at ASP+6 percent.

These information gaps make it difficult to ensure that manufacturers’ 

reported price data are accurate and that Medicare’s ASP rates developed

from this information are appropriate. 

CMS Lacks 

Information on ASP 

Necessary to Monitor 

Payment Rate 

Accuracy and 

Appropriateness 

Significantly, CMS has little information about the method a manufacturer 

uses to allocate rebates when calculating an ASP for a drug sold with other 

products. Unlike discounts, which are deducted at the point of purchase,

rebates are price concessions given by manufacturers subsequent to the 

purchaser’s receipt of the product. In our survey of hospitals’ purchase 

prices for SCODs, we found that hospitals received rebate payments 

following the receipt of some of their drug purchases but often could not 

determine rebate amounts. Calculating a rebate amount is complicated by 

the fact that, in some cases, rebates are based on a purchaser’s volume of 

a set, or bundle, of products defined by the manufacturer. This bundle may 

include more than one drug or a mixture of drugs and other products, such 

 14The burden was more taxing for some hospitals than for others. Many hospitals were able 

to rely on price data downloaded from their drug wholesalers’ information systems.

15Typically, hospitals did not systematically track all manufacturers’ rebates on drug 

purchases, although nearly 60 percent of hospitals reported receiving one or more rebates. 

Page 6 GAO-06-971T
as bandages and surgical gloves. Given the variation in manufacturers’ 

purchasing and rebate arrangements, the allocation of rebates for a 

product is not likely to be the same across all manufacturers. CMS does 

not specifically instruct manufacturers to provide information on their 

rebate allocation methods when they report ASPs. As a result, CMS lacks 

the detail it needs to validate the reasonableness of the data underlying the 

reported prices. 

In addition, CMS does not require manufacturers to report details on price 

data by purchaser type. Because a manufacturer’s ASP is a composite 

figure representing prices paid by various purchasers, including both 

health care providers and wholesalers, CMS cannot distinguish prices paid

by purchaser type—for example, hospitals compared with other 

institutional providers, physicians, and wholesalers. In particular, to the 

extent that some of the sales are to wholesalers that may subsequently 

mark up the manufacturer’s price in their sales to health care providers, 

the ASP’s representation of providers’ acquisition costs is weakened. Thus, 

distinguishing prices by purchaser type is important, as a central tenet of 

Medicare payment policy is to pay enough to ensure beneficiary access to 

services while paying pay no more than the cost of providing a service 

incurred by an efficient provider. In our 2005 report on Medicare’s 

proposed 2006 SCOD payment rates, we recommended that CMS collect 

information on price data by purchaser type to validate the reasonableness 

of ASP as a measure of hospital acquisition costs.16

Better information on manufacturers’ reported prices—for example, the 

extent to which a provider type’s acquisition costs vary from the CMScalculated ASP—would help CMS set rates as accurately as possible. For 

most types of providers of Medicare Part B drugs—physicians, dialysis 

facilities, and DME suppliers—no empirical support exists for setting rates 

at 6 percent above ASP. In the case of HOPDs, a rationale exists based on 

an independent data source—our survey of hospital prices—but the 

process of developing rates for SCODs was not simple. In commenting on 

CMS’s proposed 2006 rates to pay for SCODs, we raised questions about 

CMS’s rationale for proposing rates that were set at 6 percent above ASP.17

CMS stated in its notice of proposed rulemaking that purchase prices 

reported in our survey for the top 53 hospital outpatient drugs, ranked by 

 16GAO-06-17R. 

17GAO-06-17R. 

Page 7 GAO-06-971T
expenditures,18 equaled ASP+3 percent on average, and these purchase 

prices did not account for rebates that would have lowered the product’s

actual cost to the hospital.19 We noted that, logically, for payment rates to 

equal acquisition costs, CMS would need to set rates lower than ASP+3 

percent, taking our survey data into account. In effect, ASP+3 percent was 

the upper bound of acquisition costs. Consistent with our reasoning, CMS 

stated in its notice of proposed rulemaking that “Inclusion of ... rebates 

and price concessions in the GAO data would decrease the GAO prices 

relative to the ASP prices, suggesting that ASP+6 percent may be an 

overestimate of hospitals’ average acquisition costs.” In its final rule 

establishing SCOD payment rates, CMS determined that our survey’s 

purchase prices equaled ASP+4 percent, on average, based on an analysis

of data more recent than CMS had first used to determine the value of our 

purchase prices. CMS set the rate in the final rule at ASP+6 percent, 

stating that this rate covered both acquisition costs and handling costs.20

We have not evaluated the reasonableness of the payment rate established 

in the final rule. 

Lacking detail on the components of ASP, CMS is not well-positioned to 

confirm ASP’s accuracy. In addition, CMS has no procedures to validate 

the data it obtains from manufacturers by an independent source. In our 

2006 report on lessons learned from our hospital survey,21 we noted 

several options available to CMS to confirm the appropriateness of its 

rates as approximating health care providers’ drug acquisition costs. 

Specifically, we noted that CMS could, on an occasional basis, conduct a 

survey of providers, similar to ours but streamlined in design; audit 

manufacturers’ price submissions; or examine proprietary data the agency

considers reliable for validation purposes. HHS agreed to consider our 

recommendation, stating that it would continue to analyze the best 

approach for setting payment rates for drugs. 

 18These drugs accounted for 95 percent of Medicare spending on all SCODs in the first 

9 months of 2004. 

19The purchase prices hospitals reported to us took account of discounts but not rebates. 

20Handling costs include providers’ expenses associated with storing, preparing, and 

disposing of drugs.

21GAO-06-372. 

Page 8 GAO-06-971T
Because ASP is based on actual transaction data, is relatively timely, and is

administratively efficient for CMS and health care providers, we affirm the 

practicality of the ASP-based method for setting Part B drug payment 

rates. However, we remain concerned that CMS does not have sufficient

information about ASP to ensure the accuracy and appropriateness of the 

rates. To verify the accuracy of price data that manufacturers submit to 

the agency, details are needed—such as how manufacturers account for 

rebates and other price concessions and how they identify the purchase 

prices of products acquired through wholesalers. Equally important is the 

ability to evaluate the appropriateness of Medicare’s ASP-based rate for all 

providers of Part B drugs over time. As we recommended in our April 2006 

report, CMS should, on an occasional basis, validate ASP against an 

independent source of price data to ensure the appropriateness of ASPbased rates.

Madam Chairman, this concludes my prepared statement. I will be happy 

to answer any questions you or the other Subcommittee Members may 

have. 

For further information regarding this testimony, please contact A. Bruce 

Steinwald at (202) 512-7101 or steinwalda@gao.gov. Phyllis Thorburn, 

Assistant Director; Hannah Fein; and Jenny Grover contributed to this 

statement. Contact points for our Offices of Congressional Relations and 

Public Affairs may be found on the last page of this statement. 

Concluding 

Observations 

Contact and Staff 

Acknowledgments 

(290561) Page 9 GAO-06-971T
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