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GAO REPORT LIKELY TO SPUR MEDICARE AND MEDICAID PROGRAM INTEGRITY CHANGES

On June 7, 2012, the Government Accountability Office (GAO) issued a report on methods to reduce improper payments to Medicare and Medicaid beneficiaries. The Centers for Medicare and Medicaid Services (CMS) reported an estimated $21.9 billion of improper payments to Medicaid and $43 billion of improper payments to Medicare in year 2011 alone.  The GAO reported four suggestions to reduce the chances for fraud, waste and abuse and to recoup overpayments including: (1) strengthening provider enrollment standards and procedures to ensure that only  legitimate providers participate in the programs; (2) improving prepayment controls; (3) improving post payment claims and review  and recovery of improper payments; and (4) developing a process for identifying vulnerabilities. GAO has suggested the use of some of its methods (presently being used to reduce improper Medicare payments) to reduce improper Medicaid payments.

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