GAO Report: Further Actions Needed by CMS to Reduce Fraud in Medicare

July 2, 2014 | Strategic Insights for Health System


The Centers for Medicare and Medicaid Services (CMS) has made progress in implementing key strategies identified by the U.S. Government Accountability Office (GAO) to combat Medicare fraud, but further implementation of GAO's recommendations could help CMS better protect the program, states a June 25, 2014, GAO report. According to the report, CMS has hired contractors to determine whether providers and suppliers have valid licenses and are at legitimate locations; however, the agency could further strengthen enrollment screening by issuing a rule to require additional provider and supplier disclosures of information, such as any suspension of payments from a federal healthcare program, and establishing core elements for provider and supplier compliance programs. In terms of claims review, GAO asserts that an increased use of prepayment edits and postpayment reviews could help reduce improper Medicare payments.

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