The Centers for Medicare & Medicaid Services (CMS) uses different types of contractors to conduct prepayment and postpayment reviews of Medicare fee-for-service claims at high risk for improper payments. Medicare Administrative Contractors (MAC) conduct prepayment and postpayment reviews; Recovery Auditors (RA) generally conduct postpayment reviews; and the Supplemental Medical Review Contractor

GAO found that not all newly enrolled veterans were able to access primary care from the Department of Veterans Affairs' (VA) Veterans Health Administration (VHA), and others experienced wide variation in the amount of time they waited for care. Sixty of the 180 newly enrolled veterans in GAO's review had not been seen by providers at the time of the review; nearly half were unable to access prim

The nonemergency medical transportation (NEMT) benefits offered by Medicare and Medicaid differ. Medicare provides NEMT via ambulance only when other means of transportation, such as a taxi or wheelchair van, would jeopardize the health of the beneficiary. Medicaid NEMT is generally available for beneficiaries who have no other means of transportation to medical services. States are responsible f

The Centers for Medicare & Medicaid Services (CMS)--the agency within the Department of Health and Human Services (HHS) that oversees Medicare--has made progress in implementing several key strategies GAO identified or recommended in prior work as helpful in protecting Medicare from fraud; however, implementing other important actions that GAO recommended could help CMS and its program integrity

The Medicaid Integrity Group's (MIG) hiring of separate review and audit contractors for its National Medicaid Audit Program (NMAP) was inefficient and led to duplication because key functions were performed by both entities. Review contractors analyze state claims data to identify aberrant claims or billing anomalies while audit contractors conduct postpayment audits to determine if payments to

For fiscal year 2010, HHS reported an estimate of almost $48 billion in Medicare improper payments, representing about 38 percent of the total $125.4 billion estimate for the federal government. However, this Medicare improper payment estimate is incomplete because HHS has yet to develop a comprehensive estimate for the Medicare prescription drug benefit. The improper payment estimate includes bo

Although HHS and DOJ have taken action to address our previous recommendations aimed at improving procedures for recording HCFAC expenditures and issuing the annual HCFAC report, GAO found that controls are not sufficient to ensure that the report is accurate and supported. HHS and DOJ took action to address three of the four recommendations in GAO's 2005 report related to recording staff hours i

CMS conducted its planned on-site compliance plan audits of 33 sponsors in 2010. Findings for all of these 2010 audits are not yet available; however, CMS anticipated finalizing them in early 2011. Consistent with the audit plans CMS officials reported to us in February 2010, the agency scheduled on-site compliance plan audits to assess more thoroughly the effectiveness of sponsors' fraud and abu

In July 2008, GAO reported that CMS's review of fraud and abuse program plans was limited to the review and approval of Part D sponsors' fraud and abuse program plans submitted as part of the initial contract-application process. For example, CMS indicated that the agency did not require Part D sponsors to submit new or updated fraud and abuse program plans during the contract renewal process for

(1) With total outlays of about $46 billion in fiscal year 2008, Medicare Part D is the last significant part of Medicare for which the department has yet to develop an estimate of improper payments. In developing its estimate, it will be important for CMS to determine where the vulnerabilities and risks exist in the Medicare Part D structure and operations that could impact CMS's ability to effe