Medicaid Audit Intelligence

Publishing agency

U.S. Government Accountability Office

Reports attributed to this exact publisher identity in the indexed source metadata.

Evidence register

5 reports

Published
Jun 26, 2025
Jurisdiction
Federal
Publishing agency
U.S. Government Accountability Office
Report ID
REPORT 12

Medicaid Managed Care Improper Payment Estimate

The GAO report highlights that while CMS's current improper payment estimates for Medicaid managed care are near zero, they do not capture all program integrity risks. CMS has taken steps to improve oversight through audits and reviews, but additional measures and data improve…

Findings
5
Recommendations
4
Open evidence record
Source status
Original source
Published
Apr 16, 2024
Jurisdiction
Federal
Publishing agency
U.S. Government Accountability Office
Report ID
REPORT 27

Additional Actions Needed to Enhance Program Integrity and Save Billions

While CMS has made significant progress in reducing improper payments and implementing GAO recommendations, ongoing efforts and additional actions are necessary to further enhance program integrity, prevent fraud, and realize substantial cost savings.

Findings
5
Recommendations
5
Open evidence record
Source status
Original source
Published
Sep 21, 2023
Jurisdiction
Federal
Publishing agency
U.S. Government Accountability Office
Report ID
REPORT 15

Medicaid Program Integrity Opportunities for CMS to Strengthen Use of State Auditor Findings and Collaboration

While CMS has taken steps to improve collaboration with state auditors and analyze audit findings, there remains significant room for improvement in using these findings to enhance Medicaid program oversight and prevent improper payments.

Findings
3
Recommendations
2
Open evidence record
Source status
Original source
Published
Jun 28, 2023
Jurisdiction
Federal
Publishing agency
U.S. Government Accountability Office
Report ID
REPORT 17

Medicaid CMS Oversight and Guidance Could Improve Recovery Audit Contractor Program

CMS's oversight of the Medicaid RAC program has been inconsistent, with missed opportunities to recover overpayments and improve program effectiveness. Implementing recommended policies and conducting targeted studies could enhance the program's efficiency and recovery potential.

Findings
5
Recommendations
4
Open evidence record
Source status
Original source
Published
Jul 26, 2018
Jurisdiction
Federal
Publishing agency
U.S. Government Accountability Office
Report ID
REPORT 28

Medicaid Managed Care Improvements Needed to Better Oversee Payment Risks

The GAO found that Medicaid managed care faces significant payment risks and oversight challenges. CMS's efforts to improve program integrity have been delayed and insufficient, risking continued payment errors and fraud. Strengthening oversight and guidance is essential to mi…

Findings
3
Recommendations
3
Open evidence record
Source status
Original source