GAO's 2013 High-Risk Update: Medicare and Medicaid
Published: 2013-02-27T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: This testimony discusses GAO's 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. GAO's high-risk series has brought much-needed focus to problems impeding effective government and costing billions of dollars each year. These remarks on Medicare and Medicaid are drawn from GAO's 2013 high-risk update.
Medicare Program : 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 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.
Medicaid Program : The Medicaid program is a federal and state program that covered acute health care, long-term care, and other services for about 70 million low-income 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 state-based 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.
Kathleen King at 202-512-7114 or kingk@gao.gov or Carolyn Yocom at 202-512-7114 or yocomc@gao.gov .
section_title: What GAO Found
paragraphs: Medicare Program : 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 the Patient Protection and Affordable Care Act (PPACA) that were designed to improve the integrity of the program, such as 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.
Medicaid Program : 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.

section_title: Letter
paragraphs: 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   (See Relevant  Medicaid are drawn from GAO’s 2013 high-risk update.GAO Products for a list of reports that form the basis of this statement.)
subsections: section_title: Medicare Program
subsections: section_title: Background
paragraphs: 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.
section_title: Why Medicare is High Risk
paragraphs: 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  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 broad- based reforms to payment systems in the traditional Medicare fee-for- service (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  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.
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  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.
section_title: What Remains to Be Done
paragraphs: 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  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 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.
section_title: Medicaid Program
subsections: section_title: Background
paragraphs: The Medicaid program is a federal and state program that covered acute  health care, long-term care, and other services for about 70 million low- income 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 state- based 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.
section_title: Why Medicaid is High Risk
paragraphs: 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.
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  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.
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.
section_title: What Remains to Be Done
paragraphs: 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.
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.
section_title: Relevant GAO Products: Medicare
paragraphs: 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.
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.
section_title: Relevant GAO Products: Medicaid
paragraphs: 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.
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