establishing a program run jointly by the Department of Justice and HHS to coordinate federal, state, and local law enforcement efforts against fraud in Medicare and other health care payers; establishing a national health care fraud data collection program; and enhancing penalties and establishing health care fraud as a separate criminal offense. In addition, many of the targeted home health agencies were decertified. One chronic problem is that HCFA has not coordinated contractors’ payment safeguard activities. However, HCFA’s leadership has been absent in this area, resulting in the loss of opportunity to avoid significant Medicare expenditures. That wrongdoers continue to find ways to dodge safeguards illustrates the dynamic nature of fraud and abuse and the need for constant vigilance and increasingly sophisticated ways to protect against gaming the system. To adequately safeguard the Medicare program, HCFA needs to meet these important challenges promptly. Related GAO Products

	High Risk Series Reports on Medicare

Medicare (GAO/HR-97-10). The first copy of each GAO report and testimony is free.
Why GAO Did This Study

GAO discussed efforts to fight fraud and abuse in the Medicare program.

What GAO Found

GAO noted that: (1) it is not surprising that because of the program's size, complexity, and rapid growth, Medicare is a charter member of GAO's high risk series; (2) in this year's report on Medicare, GAO is pleased to note that both the Congress and the Health Care Financing Administration, the Department of Health and Human Services' agency responsible for running Medicare, have made important legislative and administrative changes addressing chronic payment safeguard problems that GAO and others have identified; and (3) however, because of the significant amount of money at stake, GAO believes that the government will need to exercise constant vigilance and effective management to keep the program protected from financial exploitation.