Medicare: CMS needs to address risks posed by provider enrollment waivers and flexibilities : report to congressional committees

Medicare: CMS needs to address risks posed by provider enrollment waivers and flexibilities : report to congressional committees

Collection:
Health Policy and Services Research
Alternate Title(s):
CMS needs to address risks posed by provider enrollment waivers and flexibilities: report to congressional committees
Contributor(s):
United States. Government Accountability Office, issuing body.
Publication:
Washington, DC : United States Government Accountability Office, December 2022
Language(s):
English
Format:
Text
Subject(s):
COVID-19 -- economics
Eligibility Determination -- legislation & jurisprudence
Government Regulation
Legislation, Medical
Medicare -- legislation & jurisprudence
United States
Centers for Medicare & Medicaid Services (U.S.)
Genre(s):
Technical Report
Abstract:
Why GAO did this study. Medicare is on GAO’s high-risk list due to its size, complexity, and vulnerability to improper payments, estimated at $47 billion in 2022. Medicare waivers and flexibilities during emergencies can help maintain access to Medicare services but also pose risks by removing program safeguards. The CARES Act directs GAO to monitor the federal COVID-19 pandemic response. This report (1) describes Medicare waivers and flexibilities in response to the pandemic, (2) describes changes in Medicare provider enrollment after implementing waivers and flexibilities, and (3) examines CMS’s oversight of waivers and flexibilities. GAO reviewed relevant documents including CMS policies, such as waivers and flexibilities that it had issued. GAO analyzed Medicare provider enrollment data on the use of waivers and flexibilities from March 2020 through March 2022 and Medicare claims data from April 2020 through December 2021. GAO also interviewed officials from CMS and five Medicare contractors selected based on the geographic region where they operate, among other factors. What GAO Recommends. GAO is making four recommendations to CMS including conducting fingerprint-based criminal background checks, increasing the pace of revalidating provider eligibility, and evaluating opportunities for improvement in planning for future emergencies. CMS concurred with GAO’s recommendations.
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, 45 pages))
Illustrations:
Illustrations
NLM Unique ID:
9918589885006676 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/9918589885006676