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GAO: CMS’s Efforts to Ensure Proper Payments and Identify and Recover Improper Payments

July 1, 2017

Pursuit's Take

The Centers for Medicare & Medicaid Services estimates that about $16 billion or nearly 10% of its payments to Medicare Advantage organizations were improper.

In this testimony, GAO reviews several problems found with CMS’s efforts to ensure proper payments in this program that serves about a third of Medicare beneficiaries.

For example, certain CMS audits do not target Medicare Advantage contracts at highest risk for improper payments—payments made in error or due to potential fraud. CMS has also not fully validated the data—known as “encounter data”— it uses to ensure proper Medicare Advantage payments.

Read the full report Artboard 1

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