From the U.S. Government Accountability Office, www.gao.gov Transcript for: CMS Medicaid Oversight Description: In the past four years, the Centers for Medicaid & Medicare Services (CMS) has saved more than $5 billion of Medicaid funding by finding errors in states’ spending reports. Could they be doing more? Related GAO Work: GAO-18-564: Medicaid: CMS Needs to Better Target Risks to Improve Oversight of Expenditures Released: September 2018 [ Background Music ] [ Carolyn Yocom: ] This is a critical program to over 70 million individuals. [ Matt Oldham: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. I'm Matt Oldham. One role of the Centers for Medicare and Medicaid Services, also known as CMS, is to make sure the correct amount of federal dollars matches states' Medicaid expenditures and that those states' costs themselves are correct. Last year the federal price tag for Medicaid was $370 billion. With me is Carolyn Yocom, a director on our Health Care team. And Carolyn, you led a report on CMS's oversight of Medicaid spending. What did you find? [ Carolyn Yocom: ] We took a look at what CMS does to review states' expenditures and the extent to which their reviews result in accurate and appropriate spending. [ Matt Oldham: ] Ok, so 50 states with different Medicaid programs, with different population sizes, how does CMS handle all of this? [ Carolyn Yocom: ] Yeah, it's a huge, huge task. And the variety and the flexibility that exists within the Medicaid program really makes it challenging for CMS to do a strong view and to do a consistent oversight. We did find that there needs to be a little more strategic thinking in how they go about reviewing each of the states. You can have a state that's over 10 percent of the total spending for the Medicaid program and a state that's less than 1percent. And we found that in a lot of cases, CMS was applying the same amount of resources. [ Matt Oldham: ] And did you find any other challenges for CMS? [ Carolyn Yocom: ] One of the big reasons why CMS is struggling is there's been a change in its financial oversight staffing levels and an increase in the amount of spending that's going on. So they lost about 19 percent of their staff over the last four years while expenditures have increased by 30 percent. The program has also gotten more complex. Different beneficiaries get different amounts of federal dollars. So they have less people, more dollars, and more complex dollars to review. [ Matt Oldham: ] Does this have any bearing on CMS's oversight activities? [ Carolyn Yocom: ] Yes. This is a very important part of CMS's oversight activities. In particular, it can keep the money from going out the door to begin with. So if they can review first, that's always better in program integrity. We don't like the idea of what they call paying and chasing after the dollars. So if they can review first and then educate the states so that the states also don't make those mistakes again, it's a much better proposition. [ Background Music ] [ Matt Oldham: ] Matt Oldham: So it sounds like CMS has to contend with different states' Medicaid programs as they review this Medicaid spending, and the report found that there are some challenges with CMS and oversight of Medicaid spending. So Carolyn, what did your team recommend? [ Carolyn Yocom: ] We really recommended that they think about risk. They target the states with high expenditures. They target the states that have the biggest risk problems. One state that we looked at had significant issues with just compiling the data on their expenditures. And not having this information electronically available and needing to review all that, that's clearly a state that needs a lot of attention and a lot better information systems. [ Matt Oldham: ] Last question. What do you believe is the bottom line of your report? [ Carolyn Yocom: ] The bottom line is this is a critical program to over 70 million individuals. Most often, people who have disabilities, people who are older and need long-term care, and children. And it's really critical that we make sure that every single dollar we spend goes to the right place. [ Matt Oldham: ] Carolyn Yocom is a director on our Health Care team, and she was talking about a report looking at the Centers for Medicare and Medicaid Service's oversight of Medicaid spending. Thank you for your time, Carolyn. [ Carolyn Yocom: ] Thank you. [ Background Music ] [ Matt Oldham: ] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts. [ Background Music ] [ Matt Oldham: ] For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at gao.gov.