GAO’S 2013 HIGH-RISK 

UPDATE

Medicare and Medicaid

Statement of Kathleen M. King

Director, Health Care

Carolyn L. Yocom

Director, Health Care

Testimony 

Before the Subcommittee on Health, 

Committee on Energy and Commerce, 

House of Representatives

For Release on Delivery 

Expected at 10:15 a.m. EST

Wednesday, February 27, 2013

GAO-13-433T

United States Government Accountability Office

GAO
Page 1 GAO-13-433T

United States Government Accountability Office

Washington, DC 20548

Chairman Pitts, Ranking Member Pallone, and Members of the 

Subcommittee:

Thank you for the opportunity to discuss our recent work on Medicare and 

Medicaid. Since 1990, GAO has regularly reported on programs as part of 

our high-risk series, which focuses on government operations that we 

have identified as high risk due to their greater vulnerability to fraud, 

waste, abuse, and mismanagement or their need to address economy, 

efficiency, or effectiveness challenges. Our high-risk series has brought 

much-needed focus to problems impeding effective government and 

costing billions of dollars each year. My remarks today on Medicare and 

Medicaid are drawn from GAO’s 2013 high-risk update.1 (See Relevant 

GAO Products for a list of reports that form the basis of this statement.)

In 2012, the Medicare program covered more than 49 million elderly and 

disabled beneficiaries at an estimated cost of $555 billion, and reported 

improper payments estimated to be more than $44 billion. The Centers 

for Medicare & Medicaid Services (CMS), which administers Medicare for 

the Department of Health and Human Services (HHS), is responsible for 

implementing payment methods that encourage efficient service delivery, 

managing Medicare to provide efficient and cost-effective services to 

beneficiaries, safeguarding the program from loss, and overseeing patient 

safety and care. Like health care spending in general, Medicare spending 

has grown faster than growth in the economy for many years. In the 

coming years, continued growth in the number of Medicare beneficiaries 

and program spending will create increasing challenges for the federal 

government.

GAO designated Medicare as a high-risk area in 1990 because of its 

complexity and susceptibility to improper payments, which, added to its 

size, have led to serious management challenges. Medicare spending 

must be held much more firmly in check to sustain the program over the 

 

1

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

 

Medicare Program

Background 

Why Medicare is High Risk 
 

Page 2 GAO-13-433T

long term, while continuing to ensure that beneficiaries have access to 

appropriate health care. To help do so, GAO has identified opportunities 

to make Medicare payment methods more efficient and cost-effective. In 

addition, the size of the program makes it important for CMS to manage 

program functions more effectively and better oversee the program’s 

integrity and quality of patient care. The following areas delineate where 

GAO has identified opportunities for improvements.

• Reforming and refining payments. CMS has implemented broadbased reforms to payment systems in the traditional Medicare fee-forservice (FFS) program as well as Medicare Advantage (MA) plans, 

where about a quarter of Medicare beneficiaries receive their care. 

Many reforms introduce financial incentives into payment structures to 

explicitly reward quality and efficiency. Important initiatives include 

steps toward transitioning Medicare’s FFS physician payment system 

from one that rewards volume of services to one in which value—as 

measured by quality and cost of care—is used to determine payment. 

As CMS progresses to full implementation of its value-based payment 

system, it will be important for the agency to use reliable quality and 

cost measures and methodological approaches that maximize the 

number of physicians for whom value can be determined.

GAO’s work identified opportunities for CMS to introduce additional 

payment method refinements and controls in Medicare FFS to 

encourage appropriate use of services. For example, self-referral, 

where a provider refers patients to entities in which the provider or the 

provider’s family has a financial interest, continues to be a concern for 

advanced imaging services. GAO’s analysis showed that providers’ 

referrals of advanced imaging services substantially increased once 

they start to self-refer. GAO estimated that such additional referrals 

cost more than $100 million in 1 year. Further, although Medicare’s 

payment system gives hospitals an incentive to seek the best price for 

implantable medical devices (IMD), GAO determined that hospitals 

may vary in their ability to do so. The lack of price transparency and 

variation in amounts hospitals pay for some IMDs—and may pass on 

to the Medicare program—raise questions about whether hospitals 

are achieving the best prices possible.

For the MA program, CMS has made progress implementing required 

adjustments to plan payments to align them more closely with the cost 

of care in the traditional Medicare program. However, in a January 

2012 report, GAO indicated that CMS could still improve the accuracy 

of payments to MA plans. The payment adjustment CMS makes to 

MA plans to account for differences in diagnostic coding between MA 
 

Page 3 GAO-13-433T

plans and Medicare FFS was $2.7 billion in 2010 while GAO’s 

estimate was that a more accurate adjustment would have been 

between $3.9 billion and $5.8 billion. In another report on MA plans, 

GAO reviewed a demonstration CMS established to test an alternative 

bonus payment structure. This demonstration is estimated to cost 

more than $8.3 billion over 10 years and offsets a significant portion of 

the MA payment reductions made by the Patient Protection and 

Affordable Care Act (PPACA), as amended, during its 3-year time 

frame. GAO identified significant shortcomings in the demonstration’s 

design that preclude a credible evaluation of the effect of incentives 

on plans’ quality improvement. For this reason, GAO recommended 

that the Secretary of Health and Human Services cancel the 

demonstration and implement the quality bonus payments provided 

for under the PPACA. HHS has continued the demonstration.

• Improving program management. CMS has overcome some 

challenges in managing Medicare as it implemented some recent 

program improvements. For example, GAO had previously reported 

that Medicare sometimes overpaid for durable medical equipment 

(DME) items relative to other payers. To achieve Medicare savings, in 

2009 CMS began implementing a DME competitive bidding program. 

In this program, CMS contracts with select suppliers to provide DME 

to beneficiaries and pays them at competitively determined prices 

based on the bids. GAO found that beneficiary access and 

satisfaction appeared stable in early assessments, and the 

competitive bidding program has led to savings. Similarly, in the past, 

CMS was sometimes hampered in identifying situations when 

Medicare should be the secondary payer, and the Medicare, 

Medicaid, and State Children’s Health Insurance Program Extension 

Act of 2007 mandated reporting of such situations. Since CMS’s 

implementation of the mandatory reporting for non-group health plans, 

program savings increased by $124 million from 2008 through 2011.

CMS has improved its overall guidance and oversight of contracts, an 

area where GAO found pervasive internal control weaknesses in 2009 

that put billions of taxpayers’ dollars at risk. Improvements include 

adding internal controls and testing the agency’s review of contract 

payments, adding new checklists and policies to document 

compliance with federal acquisition requirements, and enhancing its 

policies and procedures for tracking, investigating, and resolving 

contract audit and evaluation findings.
 

Page 4 GAO-13-433T

• Enhancing program integrity. The Administration and CMS have made 

reducing improper payments one of their priority initiatives. CMS has 

made progress in error rate measurement and in 2011 was able to 

report the error rate for all Medicare components for the first time, 

including the prescription drug benefit (Part D). CMS’s performance 

plan has set targets for percentages of improper payments, with the 

targets slightly lower in each year. However, as reported in 2012, the 

rate of improper payments in FFS and Part C exceeded CMS’s target 

rates. Thus, additional efforts will be needed to further reduce 

improper payments in FFS and Part C.

CMS has also taken steps to try to strengthen Medicare program 

integrity and reduce vulnerabilities to improper payment, but some 

problems have yet to be fully addressed. For example, GAO’s 

previous work found persistent weaknesses in Medicare’s enrollment 

standards and procedures that increased the risk of providing billing 

privileges to entities intent on defrauding the program. CMS has 

implemented provisions in PPACA designed to strengthen provider 

enrollment procedures in several ways, such as designating risk 

levels for categories of providers and applying different screening 

procedures for providers at each level. In addition, CMS contracted 

with two new entities at the end of 2011 to assume centralized 

responsibility for automated screening of provider and supplier 

enrollment and for conducting site visits of providers. However, CMS

has not completed other actions required by this legislation, including

(1) determining which providers will be required to post surety bonds 

to help ensure the recovery of payments made for fraudulent billing,

(2) contracting for fingerprint screening services for high-risk 

providers, (3) issuing a final regulation to require providers to disclose 

additional information, and (4) establishing core elements for provider 

compliance programs.

CMS also has implemented the Fraud Prevention System (FPS), 

which uses analytic methods to examine claims before payment to 

help identify and prioritize investigations of potential fraud. 

Specifically, FPS analyzes Medicare claims data using models of 

potentially fraudulent behavior, which results in automatic alerts on 

specific claims and providers. These alerts are then prioritized for 

program integrity analysts to review and investigate as appropriate. 

According to program integrity officials, FPS is intended to help 

facilitate the agency’s shift from focusing on recovering fraudulent 

payments after they have been made, to taking actions more quickly 

when aberrant billing patterns are identified. However, the system is 
 

Page 5 GAO-13-433T

not fully integrated with CMS’s existing information-technology 

systems, and CMS has not defined and measured quantifiable 

benefits and performance goals for it. In addition, GAO reported in 

2011 that CMS had not incorporated all the data into its Integrated 

Data Repository, as planned, which limited the repository’s use for 

identifying potentially fraudulent claims.

• Overseeing patient care and safety. For some of the most vulnerable 

beneficiaries—those in nursing homes—weaknesses remain in 

oversight of the quality of care, although CMS has taken steps to 

improve the oversight. For example, CMS contracts with state survey 

agencies to investigate complaints about nursing homes and helps 

ensure the adequacy of complaint processes by issuing guidance, 

monitoring data that state survey agencies enter into CMS’s 

database, and annually assessing state agencies’ performance 

against specific standards. However, CMS has found that states had 

difficulties meeting some of its standards for their complaint 

processes. CMS has taken steps to address GAO’s recommendations 

to improve nursing home oversight, such as strengthening 

enforcement against nursing homes that have provided poor quality 

care and by increasing the number of facilities that will be subject to 

more intensive oversight and sanctions.

To provide information to consumers and improve provider quality, in 

2008, CMS implemented the Five-Star Quality Rating System, which 

assigns each nursing home an overall rating and three component 

ratings—health inspections, staffing, and quality measures—based on 

the extent to which the nursing home meets CMS’s quality standards 

and other measures. However, CMS lacks GAO-identified leading 

strategic planning practices—the use of milestones and timelines to 

guide and gauge progress toward desired results and the alignment of 

activities, resources, and goals—that could help it more efficiently and 

effectively improve the Five-Star System.

CMS has not met GAO’s criteria to have the Medicare program removed 

from the High-Risk List. For example, although CMS has made progress 

in measuring and reducing improper payment rates in different parts of 

the program, it has yet to demonstrate sustained progress in lowering the 

rates. Because the size of Medicare relative to other programs leads to 

aggregate improper payments that are extremely large, continuing to 

reduce improper payments in this program should remain a priority for 

CMS. Further, CMS should complete some actions required by PPACA 

that were designed to improve the integrity of the program, such as 

What Remains to Be Done
 

Page 6 GAO-13-433T 

determining which providers must post surety bonds to help in recovering 

payments for fraudulent billing, using fingerprint screening for high-risk 

providers, issuing a final regulation that requires providers to disclose 

additional information, and establishing core elements for provider 

compliance programs.

To refine Medicare payment methods to encourage efficient provision of 

services, CMS should

• ensure the implementation of an effective physician profiling system, 

to help support use of value-based modifiers;

• develop and implement approaches to identify self-referred claims, 

reduce payments to recognize efficiencies achieved when the same 

provider refers and provides the service, and take steps to ensure the 

appropriateness of service provision;

• cancel the current MA Quality Bonus Demonstration and implement 

the quality bonus payment provisions in PPACA, as amended; and

• improve the accuracy of the adjustment of payments to MA plans for 

diagnostic coding differences, such as by using more current data in 

determining the amount of the adjustment.

To enhance program integrity, CMS should

• improve the structure and processes related to use of prepayment 

controls and assess the feasibility of increasing contractors’ incentives 

for their use; and

• develop or finalize schedules and plans for its information technology 

efforts related to improper payments and fraud, including the FPS; 

define quantifiable benefits, measurable performance targets, and 

goals for these efforts; and use the targets and goals to determine 

their effectiveness.

To improve oversight of patient care and safety, CMS should

• strengthen oversight of nursing home complaint investigations by 

improving the reliability of its complaints database and clarifying 

guidance for its state performance standards, and
 

Page 7 GAO-13-433T

• use strategic planning to guide and gauge the progress of its planned 

efforts to meet the goals of the Five-Star Quality Rating System for 

nursing homes.

The Medicaid program is a federal and state program that covered acute 

health care, long-term care, and other services for about 70 million lowincome people in fiscal year 2011; it is one of the largest sources of 

funding for medical and health-related services for America’s most 

vulnerable populations. Medicaid consists of more than 50 distinct statebased programs. The federal government matches state expenditures for 

most Medicaid services using the Federal Medical Assistance 

Percentage, a statutory formula based in part on each state’s per capita 

income. Medicaid is a significant expenditure for the federal government 

and the states, with total expenditures of $436 billion in 2011. CMS is 

responsible for overseeing the program at the federal level, while states 

administer their respective programs’ day-to-day operations.

GAO designated Medicaid as a high-risk program because of its size, 

growth, diversity of programs, and concerns about the adequacy of fiscal 

oversight, which is necessary to prevent inappropriate program spending. 

Both Congress and the administration have demonstrated commitment 

and leadership to making Medicaid fiscal and program integrity a priority. 

In 2012, committees in Congress held hearings on reducing Medicaid 

improper payments and on improving oversight of the program. HHS 

continues to review and report on the rate of Medicaid improper 

payments, and continues to train and provide technical assistance to 

states on approaches to prevent improper payments. Among other 

actions, CMS issued guidance to states on removing providers from their 

Medicaid programs who have been terminated for committing fraud in 

other states’ Medicaid programs or in Medicare, and required improved 

reporting and independent audits of states’ Medicaid supplemental 

payments made to certain providers known as disproportionate share 

hospitals. However, stronger federal oversight of Medicaid is warranted 

as the program continues to grow in size and spending. For example, 

potential Medicaid expansions under PPACA are estimated to result in 

the enrollment of about 7 million additional individuals in 2014, growing to 

11 million in 2022. The federal government is responsible for paying more 

than 90 percent of the increased costs associated with this expansion. 

Medicaid Program

Background 

Why Medicaid is High Risk
 

Page 8 GAO-13-433T

CMS will need new tools and resources as the law is implemented, 

including more reliable data for assessing expenditures, measuring 

performance, and preventing improper payments. Areas where program 

oversight has been insufficient include the following:

• Improper payments to Medicaid providers serving program 

beneficiaries. Improper payments to providers who submit 

inappropriate claims can result in substantial financial losses to states 

and the federal government. In its 2012 financial report, HHS 

estimated—on the basis of individual state error rates from a sample 

of 17 states reviewed on an annual rotating basis—a national 

improper payment rate for Medicaid of 7.1 percent (with the federal 

share estimated at $19.2 billion).

Positive steps toward improving transparency and reducing improper 

payments have been taken in recent years. In May 2011, CMS issued 

guidance to states on processes to remove providers from their 

program when the providers have been terminated from another 

state’s Medicaid program or terminated from Medicare as required by 

PPACA. In addition, CMS has committed to (1) redesigning its 

national Medicaid audit program, which relied on data that were 

incomplete, unreliable, and untimely, and, as a result cost significantly 

more than the potential overpayments it identified; and (2) using its 

comprehensive reviews of state integrity program activities to better 

target audits toward states with significant weaknesses in their ability 

to detect overpayments. Separate from this initiative, CMS is also 

testing the cost-effectiveness and feasibility of establishing a fraud 

prevention system for Medicaid by April 1, 2015; however key 

challenges remain, including improving key data systems so that they 

provide reliable and complete data needed to implement effective 

programs to identify and prevent improper payments; eliminating 

duplication between CMS and state program integrity efforts; and 

refocusing national audit efforts on approaches that are cost-effective.

• Financing methods that are inappropriate, and large supplemental 

payments that are not always transparent. Some states have 

established varied financing arrangements involving Medicaid 

supplemental payments that inappropriately increase federal Medicaid 

matching payments. The total amount of supplemental payments has 

increased in recent years. In fiscal year 2011, states reported 

spending at least $43 billion, up from $32 billion in fiscal year 2010 

and $23 billion in fiscal year 2006. GAO and others have reported 

concerns with states’ Medicaid supplemental payments over the last 

decade, including the use of supplemental payment arrangements to 
 

Page 9 GAO-13-433T

increase federal funding without a commensurate increase in state 

funding, and concerns that the payments were not used for Medicaid 

purposes. Large increases in reported supplemental payments have 

been identified as a major factor that contributed to increased 

Medicaid spending on hospital services in 2010.

A variety of federal legislative, regulatory, and CMS actions have 

helped curb inappropriate arrangements, but gaps remain. In 2003, 

CMS began an initiative to closely review state supplemental 

payments and required states to end those it found inappropriate; 

however, in 2008, GAO reported that CMS had not reviewed all 

supplemental payment arrangements to ensure payments were 

appropriate and were for Medicaid purposes. Starting in 2010, CMS 

implemented new transparency and accountability requirements for 

certain Medicaid supplemental payments, known as Disproportionate 

Share Hospital (DSH) payments, including new reporting and auditing 

requirements for these payments. In 2012, GAO found that the new 

requirements improve CMS’s ability to oversee DSH payments by 

better assuring that states comply with federal requirements, including 

accurate calculation of payment amounts to ensure payments are not 

excessive. However, similar standards for calculating, reporting, and 

auditing of other types of Medicaid supplemental payments—referred 

to here as non-DSH supplemental payments—have not been 

established even though these payments have increased significantly 

in recent years and exceeded DSH supplemental payments in total 

amounts. Although Medicaid payments are not limited to the costs of 

delivering Medicaid services, Medicaid payments that greatly exceed 

Medicaid costs raise questions about the purpose of the payments, 

how payments relate to Medicaid services, whether payments are 

consistent with economy and efficiency, and whether payments 

contribute to beneficiaries’ access to quality care.

• Managed care rate setting and quality of data used to set such rates 

has not been consistently reviewed by CMS. Requirements for 

Medicaid managed care rates to be actuarially sound are key 

safeguards in efforts to ensure that federal spending is appropriate. In 

2010, GAO reported that CMS had been inconsistent in ensuring that 

states are complying with the actuarial soundness requirements. 

Further, GAO found that CMS efforts were not sufficient to ensure the 

quality of the data used by states to set managed care rates. With 

limited information on data quality, CMS cannot ensure that states’ 

managed care rates are appropriate, which places billions of dollars at 

risk for misspending.
 

Page 10 GAO-13-433T

• Demonstrations that inappropriately increase federal costs. HHS has 

the authority to waive certain statutory provisions to allow states to 

implement demonstrations that test ideas for achieving program 

objectives. By policy, demonstrations should not increase federal 

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

state demonstrations that could substantially increase the federal 

financial liability. At the time of GAO’s work in 2007, HHS disagreed 

with GAO’s recommendation to improve the demonstration review 

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.

Consequentially, GAO elevated this recommendation to Congress for 

consideration. HHS subsequently reported taking steps, such as 

monitoring the spending under ongoing approved demonstrations, to 

improve its oversight; however, as of December 2012, HHS had not 

planned on any changes in the criteria and methods used to 

determine budget neutrality of demonstrations prior to approving 

them.

Congress, HHS, and CMS have taken steps to improve the fiscal integrity 

of Medicaid, and CMS has implemented certain GAO recommendations, 

such as improving the information collected on certain supplemental 

payments and issuing guidance to states to better prevent payment of 

improper claims. However, more federal oversight of Medicaid’s fiscal and 

program integrity is needed. For example, CMS oversight of program 

integrity has been challenged by data systems that do not provide 

reliable, complete, and timely data. States also have key roles in reducing 

improper payments to providers in developing, implementing, and 

evaluating the effectiveness of corrective plans to reduce improper 

payments.

CMS should also continue taking steps to improve oversight of Medicaid 

managed care payment rate-setting and Medicaid supplemental 

payments. In November 2012, GAO suggested that Congress require 

CMS to take certain steps to improve the transparency of and 

accountability for Medicaid non-DSH supplemental payments, including 

requiring improved reporting and independent audits of these payments. 

In addition, GAO’s suggestion that Congress require HHS to improve the 

criteria and methods used to ensure the budget neutrality of Medicaid 

demonstrations remains valid.

What Remains to Be Done
 

Page 11 GAO-13-433T

Thank you, Chairman Pitts, Ranking Member Pallone, and Members of 

the Committee. This concludes our testimony. We would be pleased to 

answer any questions.

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

contact Kathleen King at 202-512-7114 or kingk@gao.gov or 

Carolyn Yocom at 202-512-7114 or yocomc@gao.gov. Contact points 

for our Offices of Congressional Relations and Public Affairs may be 

found on the last page of this statement. Martin T. Gahart, Assistant 

Director; Kristin Ekelund; and Krister Friday were key contributors to this 

statement.
Relevant GAO Products: Medicare

Page 12 GAO-13-433T

Medicare Physician Payment: Private-Sector Initiatives Can Help Inform 

CMS Quality and Efficiency Incentive Efforts. GAO-13-160. Washington, 

D.C.: December 26, 2012.

End-Stage Renal Disease: Reduction in Drug Utilization Suggests 

Bundled Payment Is Too High. GAO-13-190R. Washington, D.C.: 

December 7, 2012.

Medicare Program Integrity: Greater Prepayment Control Efforts Could 

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

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

Medicare Fraud Prevention: CMS Has Implemented a Predictive 

Analytics System, but Needs to Define Measures to Determine Its 

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

Medicare: Higher Use of Advanced Imaging Services by Providers Who 

Self-Refer Costing Medicare Millions. GAO-12-966. Washington, D.C.: 

September 28, 2012.

Medicare Advantage: Quality Bonus Payment Demonstration Has Design 

Flaws and Raises Legal Concerns. GAO-12-964T. Washington, D.C.: 

July 25, 2012.

Medicare: Progress Made to Deter Fraud, but More Could Be Done. 

GAO-12-801T. Washington, D.C.: June 8, 2012.

Nursing Homes: CMS Needs Milestones and Timelines to Ensure Goals 

for the Five-Star Quality Rating System Are Met. GAO-12-390. 

Washington, D.C.: March 23, 2012.

Medicare Secondary Payer: Additional Steps Are Needed to Improve 

Program Effectiveness for Non-Group Health Plans. GAO-12-333. 

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

Medicare: Lack of Price Transparency May Hamper Hospitals’ Ability to 

Be Prudent Purchasers of Implantable Medical Devices. GAO-12-126. 

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

Medicare Physician Feedback Program: CMS Faces Challenges with 

Methodology and Distribution of Physician Reports. GAO-11-720. 

Washington, D.C.: August 12, 2011.

Relevant GAO Products: Medicare
Relevant GAO Products: Medicare

Page 13 GAO-13-433T

Fraud Detection Systems: Centers for Medicare and Medicaid Services 

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

June 30, 2011.

Nursing Homes: More Reliable Data and Consistent Guidance Would 

Improve CMS Oversight of State Complaint Investigation. GAO-11-280. 

April 7, 2011.
Relevant GAO Products: Medicaid

Page 14 GAO-13-433T

Medicaid: More Transparency of and Accountability for Supplemental 

Payments Are Needed. GAO-13-48. Washington, D.C.: November 26, 

2012.

Medicaid: States Made Multiple Program Changes, and Beneficiaries 

Generally Reported Access Comparable to Private Insurance. 

GAO-13-55. Washington, D.C.: November 15, 2012

Medicaid Integrity Program: CMS Should Take Steps to Eliminate 

Duplication and Improve Efficiency. GAO-13-50. Washington, D.C.: 

November 13, 2012.

Medicaid: Data Sets Provide Inconsistent Picture of Expenditures. 

GAO-13-47. Washington, D.C.: October 29, 2012.

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

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

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

Medicaid: States Reported Billions More in Supplemental Payments in 

Recent Years. GAO-12-694. Washington, D.C.: July 20, 2012.

National Medicaid Audit Program: CMS Should Improve Reporting and 

Focus on Audit Collaboration with States. GAO-12-627. Washington, 

D.C.: June 14, 2012.

Medicaid: Federal Oversight of Payments and Program Integrity Needs 

Improvement. GAO-12-674T. Washington, D.C.: April 25, 2012.

Medicaid Program Integrity: Expanded Federal Role Presents Challenges 

to and Opportunities for Assisting States. GAO-12-288T. Washington, 

D.C.: December 7, 2011.

Fraud Detection Systems: Centers for Medicare and Medicaid Services 

Needs to Expand Efforts to Support Program Integrity Initiatives. 

GAO-12-292T. Washington, D.C.: Dec 7, 2011.

Relevant GAO Products: Medicaid

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