Sneak Preview: Data Access, Collaborations Deemed Key Ways To Boost Payment Integrity
(The following was excerpted from a recent Thompson Grants Compliance Expert article.) Several state audit officials, at a recent symposium on federal/state partnerships hosted by the Government Accountability Office (GAO), cited the need for better access to data, skilled audit staff and more collaboration between states and the federal government as ways to improve payment integrity.
Dan Flavin, assistant director financial management and assurance at GAO, stated that for 2024, federal agencies reported improper payments within 68 programs agencywide at $162 billion (see “House Committee Urged To Avoid PRAC Closure”), about 84% of which was attributed to overpayments. In addition, GAO in 2024 estimated the total financial losses of the federal government due to fraud was between $233 billion and $521 billion based on data from federal fiscal years 2018-2022. “Fraud and improper payments erode trust in government, and we’re in an environment right now where there’s a lot of skepticism in the government’s ability to execute on its mission, so it’s very important for us to be clear about risks,” he said. “At GAO, we’ve identified areas where agencies and Congress can make improvements, and they reflect our principles in our Framework for Managing Improper Payments in Emergency Assistance Programs and our fraud risk framework.”
He noted that state governments can learn from a March GAO report that recommended five important areas for federal agencies to better manage fraud risk. These are: (1) focusing on prevention and establishing preventative controls; (2) conducting regular risk assessments and root cause analysis to help program managers develop corrective actions; (3) establishing accountability by designating a senior official with responsibility for payment integrity; (4) sharing data and using technology to identify barriers to processing payments and respond to concerns, including fraud, before making payments; and (5) preparing for future emergencies, as they are becoming costlier and more frequent, to better respond.
Ian Green, audit manager for data analytics with the Oregon Secretary of State Audits Division, discussed recent partnerships his office has had with federal agencies to improve payment integrity. For example, his office worked with the Department of Health and Human Services Office of Inspector General (OIG) on collaborative audits to review in-patient hospital stays for Medicaid recipients. The offices investigated duplicate Medicaid claims during that period. “We found instance{s} of claims billed to the program when the services were not delivered,” he said. “We identified hundreds of thousands of dollars in improper payments and made recommendations to the Oregon Health Authority to modify how they were overseeing those claims.”
(The full version of this story has now been made available to all for a limited time here.)
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