Sneak Preview: Congress, CMS Urged To Reduce Medicaid Improper Payments

April 10, 2015 | By Jerry Ashworth | Post a Comment

xsass_bookshot(The following was excerpted from an article in the Single Audit Information Service.) Congress and the Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) should consider the growing risks affecting Medicaid as they work to reduce the billions of dollars of improper payments reported under the program, according to a recent Government Accountability Office (GAO) report addressing the nation’s high-risk programs. Medicaid is a high-risk program, and the amount of improper payments increased in GAO’s most recent study.

Every two years, GAO releases a study on high-risk governmental programs to focus attention on those risks and the programs’ vulnerabilities to fraud, waste, abuse and mismanagement. In its most recent study, GAO deemed the Medicaid program as one of 32 high-risk governmental areas that need attention by Congress and the executive branch. Medicaid oversight has continually been among the programs listed on this report since 2003.

Congressional committees have held multiple hearings on improving Medicaid oversight in recent years, and CMS has issued guidance to improve state corrective actions and bolster program integrity. However, GAO reported that Medicaid improper payments have actually increased from 5.8 percent, or $14.4 billion in federal expenditures, in fiscal year 2013 to 6.7 percent, or $17.5 billion, in FY 2014.

“CMS continues to face persistent challenges that will require ongoing leadership commitment to ensure that efforts to reduce improper payments are efficient and effective,” GAO explained.

GAO added that CMS also must address emerging areas where “fundamental gaps in oversight capacity exist.” For example, more than half of Medicaid beneficiaries receive services under managed care, and states’ use of managed care is expected to increase significantly over the next five years. However, CMS and states have few policies and procedures established for overseeing managed care organizations, GAO determined.

(The full version of this story has now been made available to all for a limited time on Thompson’s Grants Compliance Expert site).


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