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GAO Finds Problems with CMS' Contract Controls

Cheryl Clark, for HealthLeaders Media, November 25, 2009

"Pervasive deficiencies" are plaguing the Centers for Medicare and Medicaid Services' internal controls over contracts, a situation which increases "the risk of improper payments or waste," according to a report made public Tuesday by the U.S. Government Accountability Office.

The agency found that based on a random sample of 2008 CMS contract actions, "at least 84.3% of fiscal year 2008 contract actions contained at least one instance where a key control was not adequately implemented."

Further, the report said, at least 37.2% of contract actions in fiscal 2008 had three or more instances in which a key control was not adequately implemented.

Among some of the deficiencies:

  • CMS used cost reimbursement contracts without first ensuring that the contractor had an adequate accounting system.

  • Project officers did not always certify invoices for payment.

  • The GAO said these deficiencies "stem from a weak overall control environment as characterized primarily by inadequate strategic planning for staffing and funding resources."

  • CMS also "did not accurately capture data on the nature and extent of its contracting, which hinders CMS' ability to manage its acquisition function by identifying areas of risk."

The GAO issued 10 recommendations for executive action to fix the problems within CMS and the Department of Health and Human Services.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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