The Government Accountability Office (GAO) released its High Risk List on February 25. The ranking, part of the “High Risk” series of reports, highlights 38 areas across the federal government that are determined to be vulnerable to waste, fraud, abuse, and mismanagement, or that are determined to be in need of transformation. Typically released at the beginning of every Congress, the list was last updated in 2023.

On this year’s list, one area has been added and 25 areas maintained status. Ten areas saw improvement that resulted in approximately $84 billion in financial benefits. Both the Medicare and Medicaid programs maintained their status on this year’s list.

Medicare

The Medicare program has been identified as high risk for improper payments; ratings on five criteria remain unchanged since the last high risk report was released. Criteria for leadership commitment and capacity are met, while criteria for the action plan, monitoring, and demonstrated progress ratings remain partially met. Several accomplishments impacting LeadingAge members were identified, such as finalized rules for identifying and recovering excess payments to Medicare Advantage plans and finalized regulations for fingerprint-based criminal background checks when revalidating provider enrollment for high risk provider types.

GAO reports 64 open recommendations for the Centers for Medicare & Medicaid Services (CMS) to strengthen the Medicare program including several recommendations related to Medicare Advantage, recommendations to increase reporting of skilled nursing facility information on Care Compare, and improving oversight of hospice providers through improved completion and reporting of standard surveys and addressing gaps in requirements for reporting allegations of abuse or neglect for individuals in hospice care.

Six recommendations remain open for congressional consideration including implementation of additional reductions in payment to skilled nursing facilities that generate Medicare spending on potentially preventable critical incidents such as hospital readmissions and emergency room visits.

Medicaid

The Medicaid program was identified for improper payments, ensuring appropriate use of program dollars, and improving the quality of program data to better manage quality of care and efficiency of payments for services. All five criteria – leadership commitment, capacity, action plan, monitoring, and demonstrated progress – received ratings of partially met and ratings are unchanged since the 2023 update. Accomplishments include CMS’s identification of key lessons from Medicaid unwinding to improve oversight of states’ compliance with federal eligibility redetermination requirements and issuing guidance in May 2024 extending requirements for states to report data used by the agency to monitor compliance during unwinding.

GAO reports 65 open recommendations related to strengthening Medicaid program integrity including strengthening collaboration with state auditors, annually monitoring states’ progress toward addressing areas of noncompliance with provider screening and enrollment requirements, and developing a policy establishing criteria to ensure that Medicaid payments at the provider level are economical and efficient and collecting and documenting provider-specific information about Medicaid payments to providers.

Three congressional considerations remain open at this time including addressing whether demonstrations that allow states to operate public managed care organizations and retain excessive revenue to support programs previously funded by the state are within the scope of the Health & Human Services’ Secretary’s authority and establishing a requirement for CMS to improve the transparency and accountability of certain Medicaid supplemental payments serving, for example, high-cost enrollees.

For more information on the criteria and recommendations of these and other high risk areas, access the full report here.