MM Curator summary
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[MM Curator Summary]: Who knew what when?
WASHINGTON—House Committee on Oversight and Accountability Chairman James Comer (R-Ky.) is requesting U.S. Government Accountability Office (GAO) Comptroller General Gene L. Dodaro initiate a review of the high number of improper payments in the Medicaid program. Chairman Comer is also requesting GAO review actions the Centers for Medicare and Medicaid Service (CMS) can take to coordinate with state auditors and improve Medicaid program integrity.
“We are writing to request the Government Accountability Office (GAO) initiate a review of improper payments in the Medicaid program. GAO has previously made more than 750 recommendations and designated Medicare and Medicaid programs as a ‘high risk area’ since 1990 due to high rates of improper payments. The size and complexity of the Medicaid program make it vulnerable to improper payments. Improper payments totaled an estimated $98.7 billion in fiscal year 2021, meaning more than one of every five Medicaid expenditures were improper. The Committee is continuing our larger oversight of CMS due to unresolved concerns about billions of dollars in wasted taxpayer funds each year,” wrote Chairman Comer.
GAO has produced multiple reports identifying weaknesses in the processes Medicaid agencies use to identify improper payments and identified necessary steps to strengthen program integrity, yet CMS has failed to take necessary action. Pandemic-era changes to Medicaid eligibility determinations drastically increased the rate of improper payments. The Oversight Committee is seeking information to ensure that GAO and CMS coordinate to take necessary steps to reduce waste, fraud, and abuse in Medicaid programs and recoup improper payments.
“During the COVID-19 pandemic, the Medicaid program suspended enforcement of eligibility reviews, resulting in millions of people receiving Medicaid benefits for which they were not eligible. While the suspension was important to ensure state’s ability to respond to the COVID-19 pandemic, according to GAO, the lack of eligibility determination audits will likely increase improper payments due to the lack of oversight. Suspending eligibility verifications prevented states from removing ineligible enrollees, compounding existing improper payment abuses,” Chairman Comer continued.
Read the letter to GAO Comptroller General Gene L. Dodaro here.