Monday, July 14, 2014

GAO Releases Fraud, Waste and Abuse Report

Dianne De La Mare

The US General Accounting Office (GAO), has released a report, Medicare Fraud: Further Actions Needed to Address Fraud, Waste and Abuse, concluding that although the Centers for Medicare & Medicaid Services (CMS) has made progress in implementing key strategies to protect the Medicare program from fraud and abuse, there are important actions that CMS must still implement. Areas where CMS needs to continue its work include provider and supplier enrollment, prepayment and post payment claims review, and identify and address vulnerabilities.

Although CMS has implemented actions to strengthen provider and supplier enrollment that addresses past weaknesses identified by GAO; it could further strengthen enrollment screening by issuing a rule to require additional provider and supplier disclosures of information. GAO also has encouraged CMS to increase its use of prepayment edits to help prevent improper Medicare payments up front. To date, CMS has yet to implement past GAO recommendations encouraging CMS for better oversight of the information systems that analysts use to identify claims for post-payment review and the contractors responsible for these reviews.

Lastly, CMS’ mechanisms and processes continue to show vulnerabilities that could lead to improper payments. For example, GAO has made multiple recommendations to CMS to remove Social Security numbers from beneficiaries’ Medicare cards to help prevent identify theft, but CMS has yet to proceed with the changes.

To obtain a complete copy of the GAO report go to

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