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Chairman Stearns, Ranking Member DeGette, and Members of the Subcommittee:
We are pleased to be here today to discuss budget considerations at the
In recent years, we have examined a broad range of issues, identified program design and oversight shortcomings, and made numerous recommendations to enhance agency operations. In particular, many of these recommendations relate to the
While HHS has successfully implemented many of our recommendations, our remarks today will focus on spending for which HHS is responsible in the context of recommendations we have made that it has yet to implement and that we therefore consider open. Specifically, we will concentrate on our recommendations to improve the
Our testimony today draws on our prior products, issued from
Missed Opportunities for Savings in
In the past several years, we have made a number of recommendations for CMS to address missed opportunities for savings in the
Minimizing improper payments and fraud. We have a body of issued and ongoing work about improper payments in
In 2010, we recommended that CMS designate responsible personnel with authority to evaluate and promptly address vulnerabilities identified to reduce improper payments. n9 CMS concurred with this recommendation and has begun to implement this process, but does not yet have written policies and procedures for a fully developed corrective action process that includes monitoring of actions taken. n10 Likewise, we recently testified before the
Enhancing payment safeguard mechanisms. In 2008, we reported on rapid spending growth for advanced imaging services. n12 We recommended that CMS examine the feasibility of adding front-end approaches, such as prior authorization, to improve payment safeguard mechanisms. CMS has not implemented our recommendation, but is currently engaged in a demonstration project to assess the appropriateness of physicians' use of advanced diagnostic imaging services furnished to
Aligning coverage for services with clinical recommendations. We reported in early 2012 that
Better reflecting beneficiary health status in payments to MA plans. In 2010, the federal government spent about
Canceling the MA Quality Bonus Payment Demonstration. We recently reported that CMS could achieve billions of dollars in savings by canceling the MA Quality Bonus Payment Demonstration--
Need for Additional Oversight of
We have conducted a substantial body of work on
Improving oversight of supplemental payments. We have reported on varied financing arrangements involving supplemental payments disproportionate share hospital (DSH) payments that states are required to make to certain hospitals and other non-DSH supplemental payments that increase federal funding without a commensurate increase in state funding. n17 Our work has found that while a variety of federal legislative and CMS actions have helped curb inappropriate financing arrangements, gaps in oversight remain. For example, while there are federal requirements designed to improve transparency and accountability for state DSH payments, similar requirements are not in place for non-DSH supplemental payments, which may be increasing. From 2006 to 2010, state-reported non-DSH supplemental payments increased from
Ensuring Medicaid demonstrations do not increase federal liability. HHS has authority to waive certain statutory provisions to allow states to implement
Improving rate-setting methodologies. In
Improved financial stewardship of federal programs is becoming increasingly important as the pressure to reduce spending mounts. In an agency as large as HHS, the need for vigilance in continuously seeking out cost savings cannot be overstated. In our work, we have examined many aspects of HHS operations and made recommendations to help HHS prevent unnecessary spending, save money, recover funds that should rightfully be returned, improve the efficiency of agency operations, and improve service for beneficiaries. HHS has implemented many of our recommendations that have proven to be financially beneficial while also enhancing program management. However, there are still recommendations we have made that remain open. While we recognize that some of the recommendations we have highlighted today are relatively new, others are several years old. HHS has made clear that it is committed to improving the nation's health and well-being while simultaneously contributing to deficit reduction. We therefore urge HHS to expedite action on our open recommendations to further advance its performance and accountability.
Chairman Stearns, Ranking Member DeGette, and Members of the Subcommittee, this completes our prepared statement. We would be pleased to respond to any questions that you may have at this time.
n1 GAO, Medicare Secondary Payer: Improvements Needed to Enhance Debt Recovery Process, GAO-04-783 (
n3 GAO, Medicaid Financing: Federal Oversight Initiative Is Consistent with Medicaid Payment Principles but Needs Greater Transparency, GAO-07-214 (
n4 GAO, High-Risk Series: An Update, GAO-11-278 (
n5 GAO, 2012 Annual Report: Opportunities to Reduce Duplication, Overlap and Fragmentation, Achieve Savings, and Enhance Revenue, GAO-12-342SP (
n7 We have ongoing work updating CMS's progress in implementing prepayment controls.
n10 We have ongoing work updating CMS's progress in implementing these recommendations.
n12 GAO, Medicare Part B Imaging Services: Rapid Spending Growth and Shift to Physician Offices Indicate Need for CMS to Consider Additional Management Practices, GAO-08-452 (
n16 We recently testified about CMS's oversight of
n18 GAO, Medicaid Demonstration Waivers: Recent HHS Approvals Continue to Raise Cost and Oversight Concerns, GAO-08-87 (
n19 GAO, Medicaid Managed Care: CMS's Oversight of States' Rate Setting Needs Improvement, GAO-10-810 (
Read this original document at: http://republicans.energycommerce.house.gov/Media/file/Hearings/Oversight/20120509/HHRG-112-IF02-Wstate-YocomC-20120509.pdf
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