GAO Reports $95 Billion Wasted in Fiscal 2016

GAO Medicaid Fraud

08 Dec GAO Reports $95 Billion Wasted in Fiscal 2016

The GAO reported this week that The Centers for Medicare & Medicaid Services must create a much more robust risk-based anti-fraud strategy for the Medicare and Medicaid programs. Improper payments within both programs amounted to about $95 billion in fiscal 2016.

The Government Accountability Office, in a report released on December 5, 2017, noted that CMS’s anti-fraud objectives only “partially align” with the GAO’s fraud risk framework, which provides guidance on designing anti-fraud initiatives. The report notes that even though CMS has implemented anti-fraud training programs for stakeholders such as providers, it does not mandate equivalent awareness training for agency employees.

The report also reported that CMS lacks a fraud risk assessment for Medicare and Medicaid, along with an anti-fraud strategy for both programs.

“By developing a fraud risk assessment and using that assessment to create an anti-fraud strategy and evaluation approach, CMS could better ensure that it is addressing the full portfolio of risks and strategically targeting the most-significant fraud risks facing Medicare and Medicaid,” the GAO said.

In response, the Department of Health and Human Services said it will advance risk-based anti-fraud strategies for both Medicare and Medicaid after it concludes its ongoing fraud-risk assessment of the federal healthcare marketplace.

The report was driven in part by previous GAO assessments that recognized both Medicare and Medicaid as being at a high risk for fraud, waste, and abuse.