GAO identified three broad areas that are contributing to the growth of Medicaid spending, which is projected to exceed $900 billion in fiscal year 2025. Improper payments, including payments made … READ MORE
Department of Health and Human Services
340B Drug Program Lacking Oversight
The 340B Drug Pricing Program requires drug manufacturers to sell outpatient drugs at discounted prices to covered entities—eligible clinics, hospitals, and others—in order to have their drugs covered by Medicaid. … READ MORE
Feds Spent Over $16 Billion On Graduate Medical Education But Don’t Know If It Is Working
According to the Government Accountability Office (GAO), "Federal agencies and state Medicaid agencies spent over $16.3 billion in 2015 to fund graduate medical education (GME) training for physicians—commonly known as … READ MORE
Lack of Data, Evaluations, and Public Reporting Strains Usefulness of $100 Billion Medicaid Demonstration Projects
GAO issued a report examining the evaluation and usefulness of Medicaid demonstration programs. Health and Human Services (HHS) has the authority to allow for states to test new ideas on … READ MORE
Medicare Continues to Make Payments for ‘Medically Unnecessary’ Services
This report is a consolidation of findings since 2000 related to Medicare's chiropractic improper payments. The two main issues involve improper payments and chiropractic fraud. In summary, CMS controls do … READ MORE
Medicare and Medicaid: CMS Needs to Fully Align Its Antifraud Efforts with the Fraud Risk Framework
"CMS, an agency within the Department of Health and Human Services (HHS), provides health coverage for over 145 million Americans through its four principal programs, with annual outlays of about … READ MORE
Further Action Needed to Expedite Use of National Data for Program Oversight
In FY 2017, Medicaid paid out $36.7 billion in improper payments. To help improve oversight and program management, In 2011, CMS began the T-MISS (Transformed Medicaid Statistical Information System) initiative … READ MORE
Health Insurance Exchanges: Changes in Plans and Premiums Effect Automatic Re-enrollment Consumers’ Costs
Under the Patient Protection and Affordable Care Act (Obamacare), consumers choose health care plans and premiums through the exchanges. The plan they select also determines the tax credit consumers receive. … READ MORE