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…
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.
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.
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.
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…