Tag Archives: Government Accountability Office

New Report Highlights Period of Transformation for the Medicaid Program, Urges Greater Federal Oversight

Obama Announces Affordable Care Act Enrollment Crosses the 8 Million Mark
The U.S. Governmental Accountability Office (GAO) has issued a new report to Congress identifying key issues facing the Medicaid program and urging greater federal oversight. The report comes at a time of significant transformation for the Medicaid program, which is currently celebrating its 50th year. Following its historic expansion as a result of the Affordable … Continue reading this entry

CMS Proposes Major Update to Medicaid Managed Care Regulations

The Centers for Medicare and Medicaid Services (“CMS”) released, on May 26, 2015, the a far-ranging proposal for revising the Medicaid managed care regulations (“Proposed Rule”).  The number of individuals enrolled in Medicaid managed care plans has increased to over 40 million. Federal Medicaid managed care regulations have not been substantially revised since they were issued … Continue reading this entry

GAO Issues Report on Post-Payment Claims Reviews by CMS Contractors

Compliance
The U.S. Government Accountability Office (GAO) recently issued a report entitled “Medicare Program Integrity: Increased Oversight and Guidance Could Improve Effectiveness and Efficiency of Post-Payment Claims Reviews,” which analyzes the processes used by the Centers for Medicare & Medicaid Services (CMS) to avoid the duplication of post-payment claims reviews by its contractors. GAO’s report focused … Continue reading this entry

Medicare's Fraud Prevention System: CMS Issues Second-Year Report to Congress

The Small Business Jobs Act of 2010 (pertinent sections of which are codified at 42 U.S.C. Section 1320a-7m) directed the Centers for Medicare & Medicaid Services (CMS) to use predictive modeling and other analytics technologies to identify and prevent fraud, waste, and abuse in the Medicare fee-for-service program. The statute required CMS to implement a … Continue reading this entry