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GAO report suggests Medicare, Medicaid improvements

April 14, 2015
by Lois A. Bowers, Senior Editor
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Medicare postpayment claims reviews and state Medicaid sources of funds are two of 24 areas where fragmentation, overlap or duplication exists in the federal government, according to a new report from the Government Accountability Office (GAO). The GAO’s annual report to Congress identifies several ways that issues can be addressed to save money.

The Medicare program’s size, complexity and susceptibility to mismanagement and improper payments earn it a spot on the GAO’s list of high-risk programs, the report notes. “To prevent inappropriate duplicative postpayment claims reviews by contractors,” the authors say, “the Centers for Medicare & Medicaid Services [CMS] should monitor the Recovery Audit Data Warehouse—the database developed in part to prevent duplicative reviews—and develop more complete guidance on contractors' responsibilities.”

The Medicaid prorgam is critical to the health of tens of millions of low-income and medically needy people, the authors state, adding that the number of beneficiaries is increasing under the Affordable Care Act. In 2014, according to the report, Medicaid served 65 million people at a cost of $508 billion. Writing of state Medicaid sources of funds, the report authors note: “To potentially save hundreds of millions of dollars, [CMS] should ensure that states report accurate and complete data on state Medicaid sources of funds so that it may better oversee states’ financing arrangements that can increase costs for the federal government.”

The GAO also has issued a supplemental guide to help analysts and policymakers and has posted testimony online.