Medicare Integrity Program

The Government Accountability Office was requested to look into how effectively the funding provided for the Centers for Medicare & Medicaid Services’ (CMS) Medicare Integrity Program (MIP) are being used to address the integrity of the Medicare Program. GAO took into account use of funding by CMS for MIP, how CMS evaluates MIP’s efficiency, and what aspects CMS considers when allotting funds.

CMS increased in total MIP funding received by $168 billion in four years, to expand MIP’s activities. Some funding was able to be transferred to different MIP programs to consolidate contractors, with the majority going to assist integrity activity. CMS claims to evaluate MIP performance by the goals to reduce wrongful payment rates for Medicare, but do not connect the effectiveness of MIP with CMS’s overall reduction goal. CMS is also unclear in communicating to its employees about the MIP program’s overall reduction goals targeting improper payments.   CMS already measures MIP effectiveness by evaluating ROI, which CMS calculates as savings from an activity in relation to expenditures. Although, the data it uses has flaws, including unreliable information for one type of contractor and not all calculations are up to date. It will be essential for CMS to correct these defects to guarantee dependability in ROI reporting. GAO has made some recommendations to CMS to fix these issues.

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