Medicare Management: CMS Faces Challenges in Safeguarding Payments While Addressing Provider Needs

In fiscal year 2000, Medicare made more than $200 billion in payments to hundreds of thousands of health care providers who served nearly 40 million beneficiaries. Because of the program's vast size and complexity, GAO has included Medicare on its list of government areas at high risk for waste, fraud, abuse, and mismanagement. GAO first included Medicare on that list in 1990, and it remains there today. GAO has continually reported on the efforts of the Health Care Financing Administration -- recently renamed the Centers for Medicare and Medicaid Services (CMS) -- to safeguard Medicare payments and streamline operations. CMS relies on its claims administration contractors to run Medicare. As these contractors have become more aggressive in identifying and pursuing inappropriate payments, providers have expressed concern that Medicare has become to complex and difficult to navigate. CMS's oversight of its contractors has historically been weak. In the last two years, however, CMS has made substantial progress. GAO has identified several areas in which CMS still need improvement, especially in ensuring that contractors provide accurate, complete, and timely information to providers on Medicare billing rules and coverage policies.