Medicaid: CMS needs to implement risk-based oversight of Puerto Rico’s procurement process : report to Congressional committees

Medicaid: CMS needs to implement risk-based oversight of Puerto Rico’s procurement process : report to Congressional committees

Collection:
Health Policy and Services Research
Contributor(s):
United States. Government Accountability Office, issuing body.
United States. Congress, issuing body.
Publication:
Washington, DC : United States Government Accountability Office, February 2021
Language(s):
English
Format:
Text
Subject(s):
Fraud -- prevention & control
Government Regulation
Medicaid -- economics
Risk Evaluation and Mitigation -- legislation & jurisprudence
Puerto Rico
United States
Genre(s):
Technical Report
Abstract:
Why GAO did this study. States’ and U.S. territories’ Medicaid procurement processes can directly affect their ability to prevent fraud, waste, and abuse in the program. A 2019 federal indictment alleging fraudulent Medicaid procurements in Puerto Rico has raised questions about the program’s oversight. The Consolidated Appropriations Act, 2020 includes a provision for GAO to review oversight of Puerto Rico’s Medicaid procurement process and its use of competition. This report examines CMS oversight of Puerto Rico’s procurement process from its initial steps through the award, and how it helps ensure competition. GAO reviewed federal regulations, guidance, and Puerto Rico’s December 2020 procurement reform plan; interviewed Puerto Rico and federal officials; and reviewed eight awards that represented about 97 percent of the costs of Puerto Rico’s procurements in effect as of April 2020. These procurements were selected based on variation in cost, use of competition, and other factors. GAO assessed whether CMS addressed risks in Puerto Rico’s procurement process by reviewing selected procurements against certain federal standards that apply to other non-federal entities and aim to mitigate the risk of fraud, waste, and abuse. GAO also assessed CMS’s policies and procedures against federal internal control standards. What GAO recommends. GAO recommends that CMS implement risk-based oversight of the Medicaid procurement process in Puerto Rico. The Department of Health and Human Services concurred with this recommendation.
Copyright:
The National Library of Medicine believes this item to be in the public domain. (More information)
Extent:
1 online resource (1 PDF file (ii, 19 pages))
NLM Unique ID:
9918317781206676 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/9918317781206676