GAO Report: Medicaid Program Integrity:Opportunities Exist for CMS to Strengthen Use of State Auditor Findings and Collaboration

post for sept 21

Why GAO Did This Study

The size and growth of Medicaid present challenges for both the federal government and states, which share program oversight responsibilities. GAO has identified gaps in CMS’s Medicaid oversight. GAO has also reported that CMS could use the work of state auditors, who are independent from their states’ Medicaid programs, to help address those gaps.

GAO was asked to examine CMS and state auditor coordination. This report describes state auditors’ Medicaid findings and the challenges they face auditing Medicaid. It also examines CMS’s use of state auditors’ findings and collaboration with auditors. GAO analyzed data on Medicaid single audit findings for fiscal years 2019 through 2021, which was the most recent data available. GAO also reviewed CMS documents and state auditor reports. In addition, GAO interviewed CMS officials and state auditors from seven selected states.

What GAO Found

State auditors play an important role in Medicaid oversight, such as conducting states’ annual single audits: audits required of entities that expend $750,000 or more in federal funding in a fiscal year. From fiscal years 2019 through 2021, state auditors identified an average of over 300 Medicaid audit findings a year, including overpayments for services provided to beneficiaries and payments to providers not enrolled in Medicaid. The Centers for Medicare & Medicaid Services (CMS) monitors states’ progress toward resolving these findings. GAO found nearly 60 percent of Medicaid single audit findings were repeated from the prior year, indicating incomplete or ineffective corrective actions.

Recommendations

GAO is making two recommendations to CMS. CMS should (1) use analysis of trends in state auditor findings to inform its oversight; and (2) strengthen its collaboration with state auditors; for example, by sharing information on those trends and the status of actions to address audit findings, and continuing to identify Compliance Supplement updates. The agency said it believes it has already implemented the first recommendation and suggested removing it. GAO maintains that the recommendation is still valid because CMS has not yet used its analysis of trends to inform its oversight. The agency concurred with the second recommendation.

Access the report here.

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