GAO Updates

Archives

July-Dec 2016

Recent Postings from GAO

October 31,2017

Opioid Use Disorders: HHS Needs Measures to Assess the Effectiveness of Efforts to Expand Access to Medication-Assisted Treatment

Over 52,000 people died of drug overdoses in 2015—and 63% of these involved opioids. For those who are addicted to or misuse opioids, medication-assisted treatment (MAT)—behavioral therapy combined with medication (such as buprenorphine)—can help. However, many people who need it don't have access to it.

See Report

October 16, 2017

Updated: Work Plan

The Office of Inspector General's (OIG) work planning process is dynamic and adjustments are made throughout the year to meet priorities and to anticipate and respond to emerging issues with the resources available.

See Report

September 29, 2017

Medicare: CMS Fraud Prevention System Uses Claims Analysis to Address Fraud

The Centers for Medicare & Medicaid Services has an IT system—the Fraud Prevention System— that analyzes claims to identify health care providers with suspect billing patterns. Program integrity contractors get leads from the system to pursue fraud investigations.

See Report

September 13, 2017

Medicaid Managed Care: CMS Should Improve Oversight of Access and Quality in States' Long-Term Services and Supports Programs

Medicaid beneficiaries who need long-term care can get it in their homes, community settings, or an institution such as a nursing home. Many states contract with managed care organizations to provide this care.

The 6 states we reviewed used various methods (e.g., beneficiary surveys) to monitor access and quality in managed long-term care programs. However, the Centers for Medicare & Medicaid Services did not always require the states to report information it needs for oversight, such as beneficiary concerns or whether there are enough providers.

See Report

Centers for Medicare and Medicaid Services: Analysis of Contracting Data

Nearly 1 in 3 Americans relies on Medicare or Medicaid for services from hospital stays and lab tests to flu shots and prescription drugs. The Centers for Medicare and Medicaid Services uses an extensive network of private contractors to administer its programs.

In FY 2016, CMS spent about $7.2 billion on these contracts, an increase of about 40% since 2012. We found that 97% of this amount went to services, such as IT and administrative support. Additionally, since competition in government contracting generally saves money, CMS increased its use of competitive contracts from 78% to 96% during this same period.

See Report

September 8, 2017

Medicaid: States Fund Services for Adults in Institutions for Mental Disease Using a Variety of Strategies

Federal and state Medicaid spending on behavioral health services—mental health and substance use treatments—is projected to be $71 billion in 2017.

However, some adults on Medicaid may have limited access to inpatient or residential behavioral health care because Medicaid generally doesn't cover services for adults in institutions for mental disease.

See Report

July 31, 2017

Bureau of Prisons: Better Planning and Evaluation Needed to Understand and Control Rising Inmate Health Care Costs

BOP lacks or does not analyze certain health care data necessary to understand and control its costs. For example, while BOP's data can show how much BOP is spending overall on health care provided inside and outside an institution, BOP lacks utilization data, which is data that shows how much it is spending on individual inmate's health care or how much it is expending on a particular health care service. BOP has identified potential solutions for gathering utilization data, but has not conducted a cost-effectiveness analysis of these solutions to identify the most effective solution.

See Report

July 27, 2017

Air Ambulance: Data Collection and Transparency Needed to Enhance DOT Oversight.

The Secretary of Transportation should: (1) communicate a method to receive air ambulance, including balance billing, complaints; (2) take steps to make complaint information publicly available; (3) assess available data and determine what information could assist in the evaluation of future complaints; and (4) consider air ambulance consumer disclosure requirements.

See Report

July 21, 2017

Medicaid Expansion: Behavioral Health Treatment Use in Selected States in 2014

Behavioral health conditions disproportionately affect low-income people. Some states expanded Medicaid to cover low-income adults, as authorized by the Affordable Care Act, so we examined how many people in this expansion group received behavioral health treatment.

See Report

Telehealth: Use in Medicare and Medicaid. Testimony

Medicare pays for some two-way video visits—referred to as "telehealth"—if the patients connect from rural health facilities. Medicare is testing new ways to provide health care that allow telehealth coverage regardless of location.

See Testimony

July 19, 2017

Medicare Advantage Program Integrity: CMS's Efforts to Ensure Proper Payments and Identify and Recover Improper Payments--Testimony

The Centers for Medicare & Medicaid Services estimates that about $16 billion or nearly 10% of its payments to Medicare Advantage organizations were improper. In this testimony, we reviewed several problems we have found with CMS's efforts to ensure proper payments in this program that serves about a third of Medicare beneficiaries.

See Testimony

July 11, 2017

Investigational New Drugs: FDA Has Taken Steps to Improve the Expanded Access Program but Should Further Clarify How Adverse Events Data Are Used.

FDA's expanded access program allows patients with serious or life threatening illnesses access to certain drugs before it has approved them. FDA also requires that manufacturers submit data about adverse reactions to these drugs. While FDA has provided some guidance to manufacturers, FDA does not fully explain the few instances when it would use these data on adverse reactions. This may influence manufacturers' decisions to give these drugs to patients due to concerns that adverse reactions will result in FDA placing a hold on their drug.

See Report

June 30, 2017

Hospital Value-Based Purchasing: CMS Should Take Steps to Ensure Lower Quality Hospitals Do Not Qualify for Bonuses

Despite the program's intention to reward hospitals that provide high-quality care at a lower cost, we found that some hospitals with low quality scores received bonuses because they had relatively high efficiency scores.

See Report

June 14, 2017

VA Information Technology: Pharmacy System Needs Additional Capabilities for Viewing, Exchanging, and Using Data to Better Serve Veterans

The Department of Veterans Affairs (VA) has system capabilities through multiple computer applications that support its clinicians and pharmacists in prescribing and dispensing medications to patients. However, pharmacists cannot always efficiently view necessary patient data among Veterans Health Administration (VHA) medical sites. In addition, pharmacists cannot transfer prescriptions to other VHA pharmacies or process prescription refills received from other VHA medical sites through the system. As a result, the system does not provide important capabilities for pharmacists to make clinical decisions about prescriptions efficiently, which could negatively affect patient safety.

See Report

June 5, 2017

New “NDC Express” Mobile Application- Drug Information Update

FDA launched a mobile application (app) to offer access to National Drug Code (NDC) data from phones or tablets. The new app, NDC Express, presents the NDC database in a mobile-friendly format, using display and navigation features available in both Android and iOS devices.

Download NDC Express for free at iTunes (for Apple devices) or Google Play store (for Android devices).

May 30, 2017

Medicare Advantage: CMS Should Use Data on Disenrollment and Beneficiary Health Status to Strengthen Oversight.

We found some contracts in which people in poor health were much more likely than others to voluntarily leave the contracts' health plans. These contracts generally had lower quality scores, and their enrollees often cited problems getting access to care.We found some contracts in which people in poor health were much more likely than others to voluntarily leave the contracts' health plans. These contracts generally had lower quality scores, and their enrollees often cited problems getting access to care.

See Report

May 24, 2017

GAO Makes MedPAC Appointments.GAO Makes MedPAC Appointments.

Gene L. Dodaro, Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO), today announced the appointment of two new members to the Medicare Payment Advisory Commission (MedPAC), as well as the reappointment of three current members.Gene L. Dodaro, Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO), today announced the appointment of two new members to the Medicare Payment Advisory Commission (MedPAC), as well as the reappointment of three current members.

See Announcement

May 3, 2017

Medicaid Demonstrations: Federal Action Needed to Improve Oversight of SpendingMedicaid Demonstrations: Federal Action Needed to Improve Oversight of Spending

Many states conduct Medicaid demonstrations, which allow them to test new approaches for delivering Medicaid services. The Centers for Medicare & Medicaid Services monitors spending under these demonstrations to ensure that the federal government does not pay more for them than it would have paid for the state's traditional Medicaid program.Many states conduct Medicaid demonstrations, which allow them to test new approaches for delivering Medicaid services. The Centers for Medicare & Medicaid Services monitors spending under these demonstrations to ensure that the federal government does not pay more for them than it would have paid for the state's traditional Medicaid program.

See Report

Medicaid Personal Care Services: More Harmonized Program Requirements and Better Data Are Needed.

A growing number of people rely on Medicaid personal care services for help with daily tasks like bathing and eating. However, these types of services are at high risk for fraud and abuse—e.g., services that were paid for but never provided.

We testified that federal and state rules for protecting Medicaid beneficiaries varied across personal care services programs. We also found that Medicaid needs better data to oversee these programs.

Medicaid Managed Care: Compensation of Medicaid Directors and Managed Care Organization Executives in Selected States in 2015Medicaid Managed Care: Compensation of Medicaid Directors and Managed Care Organization Executives in Selected States in 2015

In 2015, state Medicaid directors earned less than most top paid executives at MCOs we reviewed. Medicaid directors’ salaries in 10 states averaged $152,439, while the total compensation for top paid executives in 15 MCOs averaged $314,278.In 2015, state Medicaid directors earned less than most top paid executives at MCOs we reviewed. Medicaid directors’ salaries in 10 states averaged $152,439, while the total compensation for top paid executives in 15 MCOs averaged $314,278.

See Report

April 17, 2017

Medicaid Program Integrity: CMS Should Build on Current Oversight Efforts by Further Enhancing Collaboration with StatesMedicaid Program Integrity: CMS Should Build on Current Oversight Efforts by Further Enhancing Collaboration with States

The Centers for Medicare & Medicaid Services reviews states' efforts to reduce improper Medicaid payments, and encourages them to use collaborative audits—where CMS contractors and states work together to review the accuracy of payments made. However, some states have reported barriers (such as staff burden) to participating in collaborative audits.The Centers for Medicare & Medicaid Services reviews states' efforts to reduce improper Medicaid payments, and encourages them to use collaborative audits—where CMS contractors and states work together to review the accuracy of payments made. However, some states have reported barriers (such as staff burden) to participating in collaborative audits.

See Report

April 14, 2017

Health Care: Telehealth and Remote Patient Monitoring Use in Medicare and Selected Federal Programs.

Medicare pays for some two-way video visits—referred to as "telehealth"—if the patients connect from rural health facilities. Generally, Medicare doesn’t pay for telehealth in urban facilities or in the patient's home or office.Medicare pays for some two-way video visits—referred to as "telehealth"—if the patients connect from rural health facilities. Generally, Medicare doesn’t pay for telehealth in urban facilities or in the patient's home or office.

We talked to some health care associations, who believe that telehealth has the potential to maintain or improve quality of care and said that these rules create barriers to using telehealth.

See Report

April 10, 2017

Medicare Provider Education: Oversight of Efforts to Reduce Improper Billing Needs Improvement.

In 2016, Medicare's fee-for-service program made $41.1 billion in improper payments. To help ensure that payments are made properly, the Centers for Medicare & Medicaid Services contracts with Medicare Administrative Contractors (MACs) to educate health care providers.

See Report

March 31, 2017

Drug Compounding: Survey of State Pharmacy Regulatory Bodies

See Report

March 2, 2017

Antibiotics: FDA Has Encouraged Development, but Needs to Clarify the Role of Draft Guidance and Develop Qualified Infectious Disease Product Guidance

Each year, over 2 million Americans get sick from bacterial infections that are resistant to antibiotics, and at least 23,000 die as a result. There has also been a steady decline in the development of new antibiotics since the 1980s—raising concerns that there may not be enough new antibiotics to replace those that have become ineffective.

See Report

February 27, 2017

Electronic Health Records: HHS Needs to Improve Planning and Evaluation of Its Efforts to Increase Information Exchange in Post-Acute Care Settings.

Many patients who leave hospitals receive continuing care from places like rehab facilities (called post-acute care settings). When patients leave the hospitals and move to post-acute care settings, electronic health records can help providers know what the patient needs and better coordinate care.

However, we found that issues like increased costs and a lack of access to technology deter the use of electronic health records in these settings. See Report

February 13, 2017

Medicaid: CMS Needs Better Data to Monitor the Provision of and Spending on Personal Care Services.

Millions of Medicaid beneficiaries rely on personal care services for help with daily tasks like bathing and eating. However, these types of services are at high risk for fraud and abuse—e.g., services that were paid for but never provided.

We found that the Centers for Medicare & Medicaid Services needs better data to oversee these personal care services. In 2012, for example, $4.9 billion worth of these claims did not identify the person who provided the service. See Report.

February 8, 2017

Medicaid Managed Care: Improved Oversight Needed of Payment Rates for Long-Term Services and Supports.

States are increasingly paying for long-term care through managed care programs, paying based on set, monthly rates. How states structure these rates—aligning incentives to minimize cost and maximize service—is critical to enhancing community-based care. See Report

February 6, 2017

Medicaid: Program Oversight Hampered by Data Challenges, Underscoring Need for Continued Improvements.

Although Medicaid administrators cite a key initiative to gather new, better data and improve program oversight, they haven’t developed plans to ensure the quality of these new data, or how to use them for better oversight. See Report

January 31, 2017

Medicaid: CMS Has Taken Steps, but Further Efforts Are Needed to Control Improper Payments.

Medicaid is a joint federal-state health care program for low income and medically needy people, with an estimated $36 billion in improper payments in fiscal year 2016.The Centers for Medicare & Medicaid Services has taken steps to address some of these issues, but more work is needed—at both the state and federal levels.

See Report

January 19, 2017

Medicare Advantage: Limited Progress Made to Validate Encounter Data Used to Ensure Proper Payments

Medicare Advantage organizations—which offer a private health plan alternative to traditional Medicare—were paid about $170 billion by the federal government and served nearly one-third of all Medicare beneficiaries in 2015. To help ensure appropriate payments, the Centers for Medicare & Medicaid Services collects data on the care and health status of Medicare Advantage enrollees.

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GAO Issues First Annual Report on the Federal Government's Fiscal Health

“I remain deeply concerned about our government’s unsustainable long-term fiscal path,” said Gene Dodaro, Comptroller General of the United States and head of the GAO. “Our new report provides a frank assessment of the fiscal problems confronting the nation. Health care expenditures and net interest are now the main drivers of growing federal spending, and without policy changes, the debt-to-GDP ratio is projected to reach historic levels within 15-25 years,” he said.

See Report

GAO: Summary of Performance and Financial Information, Fiscal Year 2016.

To help determine how well we are meeting the needs of the Congress and the nation and maximizing our value as a leading practices agency, we assess our performance annually using a balanced set of quantitative measures. To establish targets for all of our performance measures, we examine our past performance and the external factors that could influence our future work and discuss with our senior executives what could be accomplished in the upcoming fiscal year.

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Drug Safety: FDA Has Improved Its Foreign Drug Inspection Program, but Needs to Assess the Effectiveness and Staffing of Its Foreign Offices.

In part to help its inspection efforts, FDA opened offices in China, India, Europe, and Latin America. Yet FDA has not assessed these offices' contributions to drug safety, and nearly half of their authorized positions are unfilled. We made recommendations on how FDA could improve in these areas.

See Report

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