Government Accountability Office

How Do Rebates Impact Part D Spending for Plans, Beneficiaries?

September 11, 2023 - While rebates may lower Medicare Part D spending for plan sponsors, they do not reduce drug costs for Medicare beneficiaries, a study conducted by the US Government Accountability Office (GAO) found. Medicare Part D drug spending surpassed $200 billion in 2021, according to GAO. Part D plan sponsors can negotiate rebates with drug manufacturers who...

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GAO: CMS Lacks Encounter Data for MA Supplemental Benefits

by Victoria Bailey

Nearly all Medicare Advantage plans offered supplemental benefits in 2022, but CMS received limited encounter data from the plans, a report from the Government Accountability Office (GAO) found. GAO...

AHIP Calls For More Accurate Federal Reporting on Medicare Advantage

by Kelsey Waddill

AHIP acknowledged the need for improved oversight for certain Medicare Advantage quality metrics but also argued that federal reporting on Medicare Advantage plans has been inaccurate in the...

GAO: Gaps Remain in Medicaid Managed Care Direct Payments Oversight

by Kelsey Waddill

Despite CMS efforts to expand oversight of Medicaid managed care direct payments and the US Government Accountability Office’s (GAO’s) previous recommendations to improve processes, the...

Downstream Impacts of Recent Surprise Billing Law Remain Uncertain

by Kelsey Waddill

The impacts related to the No Surprises Act—which Congress included in the Consolidated Appropriations Act in order to address surprise billing—remain unclear, a Kaiser Family Foundation...

Market Concentration Escalated in Small Group, Individual Markets

by Kelsey Waddill

The Government Accountability Office (GAO) has released a report finding high market concentration across the payer industry and that having increased health plan options does not necessarily reduce...

Overview of Federal Policy Around Pre-Existing Conditions Coverage

by Kelsey Waddill

Update 11/5/2020: This article has been corrected to state that the Supreme Court will hear the oral arguments regarding the Affordable Care Act’s constitutionality on November 10, 2020. A...

Aligned Enrollment Improves Dual Eligible Care Coordination

by Kelsey Waddill

Dual eligible beneficiaries who are in “aligned enrollment”—or are enrolled in both a dual eligible special needs plan and a Medicaid managed care organization under the same...

GAO Critiques HHS Actions on ACA Navigator Program Funding

by Thomas Beaton

The Government Accountability Office (GAO) has questioned the data-driven methodology behind significant reductions in funding for the ACA navigator program and subsequent declines in new enrollment in...

GAO Appoints Public Policy, Payment Experts to MedPAC

by Thomas Beaton

The Government Accountability Office (GAO) has appointed five new public policy and healthcare payment experts to the Medicare Payment Advisory Commission (MedPAC). GAO chief Gene L. Dodaro,...

GAO: Medicare DME Prior Authorization Programs are Effective

by Thomas Beaton

CMS’s prior authorization programs for durable medical equipment (DME) and mobility devices created between $1.1 and $1.9 billion in Medicare savings from 2012 to 2017 by controlling unnecessary...

CMS Value-Based Payment Programs Show Satisfactory Performance

by Thomas Beaton

CMS value-based payment programs, including Medicare accountable care organization (ACO) initiatives, have met many of their goals in recent program years, although some work remains to accelerate...

GAO Finds Several Medicare Beneficiary Data Vulnerabilities

by Thomas Beaton

CMS may have significant Medicare beneficiary data vulnerabilities because of security standards gaps within organizations that review and audit Medicare performance, a new GAO report found. GAO found...

GAO: Insufficient Data on Success of 1115 Medicaid Demonstrations

by Thomas Beaton

State and federal evaluations of 1115 Medicaid demonstrations have insufficient data to determine demonstration success because states tend report fragmented program results, according a new GAO...

GAO: CMS Needs More Data to Manage Medicare Opioid Risks

by Thomas Beaton

The Government Accountability Office (GAO) has recommended that CMS should collect additional data on Medicare beneficiary opioid risks, including the number of beneficiaries with high-dose opioid...

GAO: Medicaid Home, Community Care Create Financial Conflicts

by Thomas Beaton

Home and community-based services (HCBS) programs funded by Medicaid require additional protections from possible financial conflicts of interest, a new GAO report found. Program assessors, including...

More Choices for Federal Health Plans Doesn’t Spread Market Share

by Thomas Beaton

The federal health plan market contracted under the Office of Personnel Management (OPM) has remained heavily concentrated over the last decade, despite OPM’s efforts to improve health plan...

Claims Analytics Help Medicare Identify, Prevent Provider Fraud

by Thomas Beaton

Close to a quarter of new Medicare fraud investigations started with the use of a claims analytics platform that has helped to save approximately $6.7 million in incorrect billings, a new GAO report...

6 Ways VA Can Improve Administrative Management of Care Delivery

by Thomas Beaton

Even though VA has taken steps to improve administration and management of its healthcare delivery systems, the Government Accountability Office (GAO) found six action items that allows the VA to...

GAO: Veterans Affairs Insurance Enrollment Standards Lacking

by Thomas Beaton

The Department of Veterans Affairs is one of the largest healthcare organizations that provides health benefits, but their enrollment standards and processes lead to delays and errors, according to a...

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