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2,200 | ion effort by supporting UAS standards and rulemaking and supporting research planning and progress, among other efforts. MITRE brings together the federal agencies— FAA, NASA, DOD, DHS, and others—to advance UAS integration. In its role, according to MITRE officials, one of the biggest challenges is how to integrate all the UAS-related work across the federal government, academia, and private sector. Grants: In August 2014, FAA awarded two grants to Georgia Tech Research Corporation and the University of N |
2,201 | orth Dakota to conduct literature reviews of UAS issues. Georgia Tech is collecting information on research being conducted on the effect of UAS collisions on other airborne and ground based objects. The University of North Dakota is looking at the UAS safety criteria and particularly if UASs could be deadly. According to FAA, both studies will support ongoing UAS research and help determine the applicability of past studies. Center of Excellence: In May 2015, FAA selected a team led by Mississippi State Un |
2,202 | iversity as the Center of Excellence for UAS.According to FAA, the goal of the Center of Excellence will be to create a cost-sharing relationship among academia, industry, and government that will focus on the primary research areas needed to support UAS integration. FAA hopes the center could provide both short- and long-term research through testing and analysis. In support of it serving this purpose, the Center of Excellence has an annual $500,000 budget for the next 10 years. FAA also has additional res |
2,203 | ources to support the UAS integration, including facilities working on research and development and management of FAA’s other research and development efforts for UAS integration. FAA’s William J. Hughes Technical Center houses staff in charge of supporting and managing FAA’s designated test sites. While the test sites do not have specific funding, FAA has dedicated resources located at Hughes Technical Center to support the set up and ongoing operations of the test sites. For example, COA data are collecte |
2,204 | d and analyzed at the Hughes Technical Center. In addition, FAA has participated in the twice-a-year technical interchange meetings with the test sites. These meetings have brought together the test sites and FAA to address issues in the set-up and operation of the test sites. Furthermore, FAA has staff supporting the test sites through review of test site operation and safety procedures and manuals to support the monthly reporting of the operational and safety data required by each COA. The William J. Hugh |
2,205 | es Technical Center is located in Atlantic City, New Jersey, and contains laboratories supporting aviation research, development, testing, and evaluation of air traffic control and aircraft safety among other aviation areas. It also serves as the primary facility supporting the Next Generation Air Traffic System. According to numerous studies and stakeholders we interviewed, many countries around the world, have been allowing commercial UAS operations in their airspace for differing purposes. We also identi |
2,206 | fied a number of countries that allow commercial UAS operations and have done so for years. Specifically, Canada and Australia have regulations pertaining to UAS that have been in place since 1996 and 2002, respectively. According to a recent MITRE study, the types of commercial operations allowed vary by country and include aerial surveying, photography, and other lines of business. For example, Japan has allowed UAS operations in the agriculture industry since the 1980’s to help apply fertilizer and pesti |
2,207 | cide. EASA is the European Union Authority in aviation safety. The main activities of the organization include the strategy and safety management, the certification of aviation products and the oversight of approved organizations and EU Member States. require a risk assessment of the proposed operation and an approval to operate under restrictions specific to the operation. The final proposed category, certified operations, would be required for those higher-risk operations, specifically when the risk rises |
2,208 | to a level comparable to manned operations. This category goes beyond FAA’s proposed rules by proposing regulations for large UAS operations and operations beyond the pilot’s visual line of sight. As other countries work toward integration, standards organizations from Europe and the United States are coordinating to try and ensure harmonized standards. Specifically, RTCA and the European Organization for Civil Aviation Equipment (EUROCAE) have joint committees focused on harmonization of UAS standards. We |
2,209 | studied the UAS regulations of Australia, Canada, France, and the United Kingdom and found that these countries impose similar types of requirements and restrictions on commercial UAS operations. For example, all these countries except Canada require government-issued certification documents before UASs can operate commercially.addition, each country requires that UAS operators document how they ensure safety during flights and their UAS regulations go into significant detail on subjects such as remote pil |
2,210 | ot training and licensing requirements. For example, the United Kingdom has established “national qualified entities” that conduct assessments of operators and make recommendations to the Civil Aviation Authority as to whether to approve that operator. Similar regulations in these countries continue to evolve. In November 2014, Canada issued new rules creating exemptions for commercial use of small UASs weighing 4.4 pounds or less and from 4.4 pounds to 55 pounds. UASs in these categories can commercially o |
2,211 | perate without a government-issued certification but must still follow operational restrictions, such as a height restriction and a requirement to operate within line of sight. Transport Canada officials told us this arrangement allows them to use scarce resources to regulate situations In of relatively high risk. Australia, in similar fashion, is considering relieving UASs lighter than 4.4 pounds from its requirement to obtain a UAS Operator’s certificate. France’s regulation describes 4 weight-based categ |
2,212 | ories of UAS as well as 4 operational scenarios of increasing complexity. The regulations then discuss which UAS categories can operate in each scenario. FAA, by electing to focus on UASs up to 55 pounds in its Small UAS NPRM, has taken a similar risk-based approach. The United States has not yet finalized regulations specifically addressing its small UAS operations, but if UASs were to begin flying today in the national airspace system under the provisions of FAA’s proposed rules, their operating restricti |
2,213 | ons would be generally similar to regulations in these other four countries. However, there would be some differences in the details. For example, FAA proposes altitude restrictions of below 500 feet, while Australia, Canada, and the United Kingdom restrict operations to similar but slightly lower altitudes. Other proposed regulations require that FAA certify UAS pilots prior to commencing operations, while Canada and France do not require pilot certification in certain low risk scenarios. While FAA continu |
2,214 | es to finalize the small UAS rule—a process that could take until late 2016 or early 2017—other countries continue to move ahead with UAS integration. Thus, when the rule is finalized the operating restrictions in this country may be well behind what exists in other countries if the final rule reflects the proposed rule. Table 6 shows how FAA’s proposed rules compare with the regulations of Australia, Canada, France, and the United Kingdom. While regulations in these countries generally require that UAS ope |
2,215 | rations remain within the pilot’s visual line of sight, some countries are moving toward allowing limited operations beyond the pilot’s visual line of sight. For example, according to Australian civil aviation officials, they are developing a new UAS regulation that would allow operators to request a certificate allowing beyond-line-of-sight operations. However, use would be very limited and allowed only on a case-by-case basis. Similarly, according to a French civil aviation official, France approves on a |
2,216 | case- by-case basis, very limited beyond-line-of-sight operations. Finally, in the United States, there have been beyond-line-of-sight operations in the Arctic, and NASA, FAA and the UAS industry have successfully demonstrated detect-and-avoid technology, which is necessary for beyond line-of-sight operations. Like the United States, Australia, Canada, France, and the United Kingdom distinguish between recreational model aircraft and commercial UASs and have issued guidelines for safe operation. For example |
2,217 | , the United Kingdom defines model aircraft as any small unmanned aircraft, weighing less than 44 pounds, or large unmanned aircraft weighing more than 44 pounds, that is used for sporting and recreational purposes. Australia makes no practicable distinction between a small UAV and a model aircraft except that of use—model aircraft are flown only for the sport of flying them. However, Australia also defines a giant model aircraft as one weighing between 55 pounds and 331 pounds. Approvals for commercial UAS |
2,218 | operations have increased in these four countries and some allow more commercial operations. Since 2011 the number of approvals for commercial operations in France has increased every year. According to a Civil Aviation Authority official, in 2014, there were about 3,600 commercial UAS operators. In Canada, according to a Transport Canada official, there were over 1,600 approvals for commercial and research related UAS operations in 2014. As previously mentioned, certain commercial operations in Canada do |
2,219 | not need approval as of November 2014 and there may be even more UAS operations. The United Kingdom’s Civil Aviation Authority attributes the growth to UASs in their country to the UASs’ becoming less expensive and simpler to operate. In the United Kingdom, as of February 2015, there were 483 commercial UAS operators, and this number has increased every year since 2010. Similar to the United Kingdom, Australia has seen an increase in commercial UAS operators since 2010 with currently over 200 approved comme |
2,220 | rcial operators. Australia’s Parliament attributes the growth to improvements in UASs’ piloting and control technologies, as well as reductions in UAS prices. With FAA’s approvals for commercial exemptions exceeding 500 as of June 9, 2015, the United States has closed the gap with some other countries’ level of commercial use. Other countries face challenges that are common across some countries, including the United States, trying to integrate UAS operations. Specifically, some of the challenges are: Techn |
2,221 | ology shortfalls and unresolved spectrum issues. Technology needs and concerns about available spectrum constrain full integration of UASs into airspace with manned aircraft in the United States and in countries around the world. UASs’ current inability to detect and avoid other aircraft, the lack of a standard for command and control systems, and no dedicated and secure frequency spectrum are technical challenges preventing full UAS integration into the national airspace. However, organizations around the |
2,222 | world are looking to address these technology issues and develop standards to support safe UAS operations. At the worldwide level, the International Civil Aviation Organization is addressing how UAS integration would affect its existing standards. At the European level, the European UAS Roadmap contains a strategic research and development plan that describes anticipated deliverables along with key milestones, timelines, and resources needed. Separate from the international organizations, researchers in ind |
2,223 | ividual countries are also addressing these challenges. For example, in February 2014, Australian researchers achieved what was then believed to be a world-first breakthrough for small UASs by developing an onboard system that has enabled a UAS to detect another aircraft using vision while in flight. Safe operations by recreational users. Countries around the world also face challenges in ensuring that UAS purchasers operate them safely. As UASs become more affordable, and increasingly available some indivi |
2,224 | duals are conducting unsafe or illegal UAS operations. In July 2014, Australia’s Parliament reported on testimony, from several witnesses, that UASs are being flown by operators who unknowingly break safety rules, thereby posing a safety risk to manned aircraft and persons on the ground. In response to unsafe operations, a few countries have placed outright bans on UAS operations. For example, in India, in response to the surge in interest for commercial and recreational use, the government placed an outrig |
2,225 | ht ban on any UAS use until its civil aviation agency issues regulations. Similar to the “Know Before You Fly” education campaign in this country, other countries have sought to educate operators. For example, the United Kingdom has developed and distributed a brochure describing safe flying practices. In Australia, UAS purchasers receive a similar document when they purchase the product. Canada has launched a national safety awareness campaign for UASs, which aims to help Canadians better understand the ri |
2,226 | sks and responsibilities of flying UASs. In addition, Transport Canada has set up a web page that provides safe guidelines for flying UASs and answers frequently asked questions While countries face some UAS integration challenges that are similar to the United States, other challenges such as airspace complexity and ease of regulatory change, can make integration in this country more difficult. Airspace complexity is one aspect in which the United States differs from other countries. According to FAA, the |
2,227 | U.S. airspace is the busiest and most complex in the world, where UASs, after integration, would share with more than 300,000 general aviation aircraft, ranging from amateur-built aircraft, rotorcraft, and balloons, to highly sophisticated Introducing potentially large numbers of UAS turbojets (executive jets).by hobbyists, farmers, law enforcement agencies, and others would add to this complexity. In contrast, according to a study by MITRE, other countries have fewer aviation aircraft, a situation that may |
2,228 | make integrating UAS easier. For example, the U.K. has about 20,000 registered general aviation aircraft, while Australia has around 8,400. A study conducted by MITRE for FAA indicated this factor as one that can affect the speed of change and adaptation in various aviation environments. We provided a draft of this report to Department of Transportation (DOT) for review and comment. In comments, which were provided in an email, DOT stated that the report addresses many of the challenges of UAS integration |
2,229 | but does not address any environmental concerns and that the report should state that it did not examine the environmental considerations of UAS integration. DOT further noted that FAA is conducting research to understand the environmental impacts of UAS integration, the role that UASs play in National Environmental Policy Act compliance, and the applicability of noise standards regulations to UASs.integration. The discussion of challenges in the report does not mention environmental concerns because it foc |
2,230 | uses on challenges the test sites faced during their first year of operation, as reported by the test site operators. We did clarify in our scope and methodology description that we did not cover environmental considerations of UAS integration. DOT also provided technical comments on the draft that we incorporated as appropriate. We did not examine the environmental considerations of UAS As agreed with your offices, unless you publicly announce the contents of this report earlier, we plan no further distrib |
2,231 | ution until 30 days from the report date. At that time, we will send copies to the Secretary of Transportation and the appropriate congressional committees. In addition, the report will be available at no charge on the GAO website at http://www.gao.gov. If you or your staff have any questions about this report, please contact me at (202) 512-2834 or [email protected]. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. GAO staff who ma |
2,232 | de key contributions to this report are listed in appendix III. This report focuses on FAA’s efforts to develop procedures to allow UAS use within the national airspace system. Specifically, we reviewed (1) the status of FAA’s progress toward safe integration of UAS into the national airspace, (2) research and development support from FAA’s test sites and other resources, and (3) how other countries have progressed toward UAS integration into their airspace for commercial purposes. To address the three obje |
2,233 | ctives, we reviewed and synthesized a range of published reports from GAO and FAA that included general background information on a variety of related issues, such as FAA’s framework for UAS integration, efforts to accommodate ongoing research and commercial UAS use, and UAS technology challenges. We reviewed other relevant background literature on related issues, including results from databases, such as ProQuest® and Nexis®, trade publications, literature from industry stakeholder groups, and information |
2,234 | from the Internet. We also reviewed provisions of the FAA Modernization and Reform Act of 2012, and the Notice of Proposed Rulemaking for small UAS operations. In addition, we reviewed more detailed and specific documentation related to the different objectives, as described below. To determine FAA’s progress toward safe integration of UAS into the national airspace, we: Reviewed documents provided by officials and conducted semi- structured interviews with officials at federal agencies, including the FAA’s |
2,235 | Unmanned Aircraft Systems Integration and Research and Development Offices, the Department of Defense (DOD), the National Aeronautics and Space Administration (NASA), and the Department of Homeland Security. We reviewed FAA’s Comprehensive Plan and Roadmap for UAS integration. Interviewed representatives from FAA’s Joint Planning and Development Office, the UAS Aviation Rulemaking Committee, RTCA, and MITRE Corporation as well as voluntary standards development organization ASTM International. We interview |
2,236 | ed representatives from the Association for Unmanned Vehicle Systems International, Aircraft Owners and Pilots Association, American Institute of Aeronautics and Astronautics, and the Academy of Model Aeronautics. We also obtained information on the Federal Modernization and Reform Act of 2012 Section 333 exemptions FAA granted from FAA and http://www.regulations.gov2014 to May 2015. Reviewed documents provided by and interviewed federal and industry representatives from the collaborative groups—the Executi |
2,237 | ve Committee, RTCA Special Committee 228, UAS Aviation Rulemaking Committee, and ASTM International Committee F38—and industry groups that are involved in FAA’s efforts to integrate UAS into the national airspace system To identify research and development support from FAA’s test sites and other resources, we: Reviewed and analyzed documents from each of the six test sites where FAA has recently allowed UAS operations including the applications submitted by the selected test sites and quarterly reports prov |
2,238 | ided to FAA. Conducted semi-structured interviews with officials from the test sites, including the State of Nevada, the University of Alaska, the North Dakota Department of Commerce, Griffiss International Airport, the Virginia Polytechnic Institute & State University, and Texas A&M University Corpus Christie to determine the issues encountered in an effort to become operational, conduct research, share the research results with FAA, and receive support or guidance from FAA. Spoke with representatives from |
2,239 | other universities with centers of research on UAS technology and issues, including New Mexico State University, Massachusetts Institute of Technology Lincoln Laboratory, the Humans and Autonomy Lab at Duke University, and the Georgia Institute of Technology to obtain information about the resources FAA has dedicated to conducting other UAS research and development. To identify how the United States compares to other countries in the progress and development of UAS use for commercial purposes, we: Develope |
2,240 | d case studies for four countries that have made progress in integrating UASs into their national airspace—France (Direction générale de l’aviation civile); the United Kingdom (UK Civil Aviation Authority); Australia (Australia Civil Aviation Safety Authority); and Canada (Transport Canada Civil Aviation). We selected these countries based on several factors including the status of regulatory requirements for commercial UASs, beyond-line-of-site activities, and whether the country allows non-military UAS to |
2,241 | operate in the airspace. We obtained the UAS regulations of each country and interviewed civil aviation authorities in each to obtain additional information about the issues encountered with UAS. Interviewed other stakeholders familiar with the UAS activities currently occurring in other countries to determine the factors that influenced their country’s policies regarding UASs including the International Civil Aviation Organization (ICAO). We conducted this performance audit from January 2014 to July 2015 |
2,242 | in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives. FAA Modernization and Reform Act of 2012 requirement Enter into agreements with appropriate government agencies to si |
2,243 | mplify the process for issuing Certificates of Waiver or Authorization (COA) or waivers for public unmanned aerial systems (UAS). Status of action In process—memorandum of agreement (MOA) with DOD signed Sept. 2013; MOA with Department of Justice signed Mar. 2013; MOA with NASA signed Mar. 2013; MOA with Department of Interior signed Jan. 2014; MOA with the Office of the Director, Operational Test and Evaluation (DOD) signed Mar. 2014; MOA with National Oceanic and Atmospheric Administration still in draft. |
2,244 | Expedite the issuance of COAs for public safety entities Establish a program to integrate UASs into the national airspace at six test ranges. This program is to terminate 5 years after date of enactment. Develop an Arctic UAS operation plan and initiate a process to work with relevant federal agencies and national and international communities to designate permanent areas in the Arctic where small unmanned aircraft may operate 24 hours per day for research and commercial purposes. Determine whether certain |
2,245 | UAS can fly safely in the national airspace before the completion of the Act’s requirements for a comprehensive plan and rulemaking to safely accelerate the integration of civil UASs into the national airspace or the Act’s requirement for issuance of guidance regarding the operation of public UASs including operating a UAS with a COA or waiver. Develop a comprehensive plan to safely accelerate integration of civil UASs into national airspace. Issue guidance regarding operation of civil UAS to expedite COA |
2,246 | process; provide a collaborative process with public agencies to allow an incremental expansion of access into the national airspace as technology matures and the necessary safety analysis and data become available, until standards are completed and technology issues are resolved; facilitate capability of public entities to develop and use test ranges; provide guidance on public entities’ responsibility for operation. Make operational at least one project at a test range. Approve and make publically availab |
2,247 | le a 5-year road map for the introduction of civil UAS into national airspace, to be updated annually. Submit to Congress a copy of the comprehensive plan. Publish in the Federal Register the Final Rule on small UAS. FAA Modernization and Reform Act of 2012 requirement Publish in the Federal Register a Notice of Proposed Rulemaking to implement recommendations of the comprehensive plan. Publish in the Federal Register an update to the Administration’s policy statement on UAS in Docket No. FAA-2006-25714. Ac |
2,248 | hieve safe integration of civil UAS into the national airspace. Publish in the Federal Register a Final Rule to implement the recommendations of the comprehensive plan. Develop and implement operational and certification requirements for public UAS in national airspace. In addition to the contact named above, the following individuals made important contributions to this report: Brandon Haller, Assistant Director; Geoffrey Hamilton, Daniel Hoy, Eric Hudson, Bonnie Pignatiello Leer, Ed Menoche, Josh Ormond, |
2,249 | Amy Rosewarne, Andrew Stavisky, and Sarah Veale. |
2,250 | Since 1996, Congress has taken important steps to increase Medicare program integrity funding and oversight, including the establishment of the Medicare Integrity Program. Table 1 summarizes several key congressional actions. CMS has made progress in strengthening provider enrollment provisions, but needs to do more to identify and prevent potentially fraudulent providers from participating in Medicare. Additional improvements to prepayment and postpayment claims review would help prevent and recover improp |
2,251 | er payments. Addressing payment vulnerabilities already identified could further help prevent or reduce fraud. PPACA authorized and CMS has implemented new provider enrollment procedures that address past weaknesses identified by GAO and HHS’s Office of Inspector General (OIG) that allowed entities intent on committing fraud to enroll in Medicare. CMS has also implemented other measures intended to improve existing procedures. Specifically, to strengthen the existing screening activities conducted by CMS co |
2,252 | ntractors, the agency added screenings of categories of provider enrollment applications by risk level, contracted with new national enrollment screening and site visit contractors, and began imposing moratoria on new enrollment of certain types of providers. Screening Provider Enrollment Applications by Risk Level: CMS and OIG issued a final rule in February 2011 to implement many of the new screening procedures required by PPACA. CMS designated three levels of risk—high, moderate, and limited—with differe |
2,253 | nt screening procedures for categories of Medicare providers at each level. Providers in the high-risk level are subject to the most rigorous screening. Based in part on our work and that of OIG, CMS designated newly enrolling home health agencies and suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) as high risk, and designated other providers as lower risk levels. Providers at all risk levels are screened to verify that they meet specific requirements established by Med |
2,254 | icare, such as having current licenses or accreditation and valid Social Security numbers. High- and moderate-risk providers are also subject to unannounced site visits. Further, depending on the risks presented, PPACA authorizes CMS to require fingerprint-based criminal history checks. Last month, CMS awarded a contract that will enable the agency to access Federal Bureau of Investigation information to help conduct those checks of high-risk providers and suppliers. PPACA also authorizes the posting of sur |
2,255 | ety bonds for certain providers. CMS has indicated that the agency will continue to review the criteria for its screening levels and will publish changes if the agency decides to update the assignment of screening levels for categories of Medicare providers. Doing so could become important because the Department of Justice (DOJ) and HHS reported multiple convictions, judgments, settlements, or exclusions against types of providers not currently at the high-risk level, including community mental health cente |
2,256 | rs and ambulance providers. CMS’s implementation of accreditation for DMEPOS suppliers, and of a competitive bidding program, including in geographic areas thought to have high fraud rates, may be helping to reduce the risk of DMEPOS fraud. While continued vigilance of DMEPOS suppliers is warranted, other types of providers may become more problematic in the future. Specifically, in September 2012, we found that a range of providers have been the subjects of fraud investigations. According to 2010 data from |
2,257 | OIG and DOJ, over 10,000 providers that serve Medicare, Medicaid, and Children’s Health Insurance Program beneficiaries were involved in fraud investigations, including not only home health agencies and DMEPOS suppliers, but also physicians, hospitals, and pharmacies.In addition, the provider type constituting the largest percentage of subjects in criminal health care fraud investigations was medical facilities—including medical centers, clinics, or practices—which constituted almost a quarter of subjects |
2,258 | in such investigations. DMEPOS suppliers make up a little over 16 percent of subjects. National Enrollment Screening and Site Visit Contractors: CMS contracted with two new types of entities at the end of 2011 to assume centralized responsibility for two functions that had been the responsibility of multiple contractors. One of the new contractors is conducting automated screenings to check that existing and newly enrolling providers and suppliers have valid licensure, accreditation, and a National Provider |
2,259 | Identifier (NPI), and are not on the OIG list of providers and suppliers excluded from participating in federal health care programs. The second contractor conducts site visits of providers to determine whether sites are legitimate and the providers meet certain Medicare standards. implementation of the PPACA screening requirements, the agency had revoked over 17,000 suspect providers’ ability to bill the Medicare program. Site visits for DMEPOS suppliers are to continue to be conducted by the contractor r |
2,260 | esponsible for their enrollment. In addition, CMS at times exercises its authority to conduct a site visit or request its contractors to conduct a site visit for any Medicare provider or supplier. Moratoria on Enrollment of New Providers and Suppliers in Certain Areas: CMS suspended enrollment of new home health providers and ambulance suppliers in certain fraud “hot spots” and other geographic areas. In July 2013, CMS first exercised its authority granted by PPACA to establish temporary moratoria on enroll |
2,261 | ing new home health agencies in Chicago and Miami, and new ambulance suppliers in Houston. In January 2014, CMS extended its first moratoria and added enrollment moratoria for new home health agency providers in Fort Lauderdale, Detroit, Dallas, and Houston, and new ground ambulance suppliers in Philadelphia. These moratoria are scheduled to be in effect until July 2014, unless CMS extends or lifts them. CMS officials cited areas of potential fraud risk, such as a disproportionate number of providers and su |
2,262 | ppliers relative to beneficiaries and extremely high utilization as rationales for suspending new enrollments of home health providers or ground ambulance suppliers in these areas. We are currently examining the ability of CMS’s provider enrollment system to prevent and detect the continued enrollment of ineligible or potentially fraudulent providers in Medicare. Specifically, we are assessing the process used to enroll and verify the eligibility of Medicare providers in Medicare’s Provider Enrollment, Chai |
2,263 | n, and Ownership System (PECOS) and the extent to which CMS’s controls are designed to prevent and detect the continued enrollment of ineligible or potentially fraudulent providers in PECOS. Although CMS has taken many needed actions, we and OIG have found that CMS has not fully implemented other enrollment screening actions authorized by PPACA. These actions could help further reduce the enrollment of providers and suppliers intent on defrauding the Medicare program. They include issuing a rule to implemen |
2,264 | t surety bonds for certain providers, issuing a rule on provider and supplier disclosure requirements, and establishing the core elements for provider and supplier compliance programs. Surety Bonds: PPACA authorized CMS to require a surety bond for certain types of at-risk providers and suppliers. Surety bonds may serve as a source for recoupment of erroneous payments. DMEPOS suppliers are currently required to post a surety bond at the time of enrollment. CMS reported in April 2014 that it had not schedule |
2,265 | d for publication a proposed rule to implement the PPACA surety bond requirement for other types of at-risk providers and suppliers—such as home health agencies and independent diagnostic testing facilities. In light of the moratoria that CMS has placed on enrollment of home health agencies in fraud “hot spots,” implementation of this rule could help the agency address potential concerns for these at-risk providers across the Medicare program. Providers and Suppliers Disclosure: CMS has not yet scheduled a |
2,266 | proposed rule for publication for increased disclosures of prior actions taken against providers and suppliers enrolling or revalidating enrollment in Medicare, as authorized by PPACA, such as whether the provider or supplier has been subject to a payment suspension from a federal health care program. Agency officials had indicated that developing the additional disclosure requirements has been complicated by provider and supplier concerns about what types of information will be collected, what CMS will do |
2,267 | with it, and how the privacy and security of this information will be maintained. Compliance Program: CMS has not established the core elements of compliance programs for providers and suppliers, as required by PPACA. We previously reported that agency officials indicated that they had sought public comments on the core elements, which they were considering, and were also studying criteria found in OIG model plans for possible inclusion.had not yet scheduled a proposed rule for publication. Medicare uses pr |
2,268 | epayment review to deny claims that should not be paid and postpayment review to recover improperly paid claims. As claims go through Medicare’s electronic claims payment systems, they are subjected to prepayment controls called “edits,” most of which are fully automated; if a claim does not meet the criteria of the edit, it is automatically denied. Other prepayment edits are manual; they flag a claim for individual review by trained staff who determine whether it should be paid. Due to the volume of claims |
2,269 | , CMS has reported that less than 1 percent of Medicare claims are subject to manual medical record review by trained personnel. Increased use of prepayment edits could help prevent improper Medicare payments. Our prior work found that, while use of prepayment edits saved Medicare at least $1.76 billion in fiscal year 2010, the savings could have been greater had prepayment edits been used more widely. Based on an analysis of a limited number of national policies and local coverage determinations (LCD), we |
2,270 | identified $14.7 million in payments in fiscal year 2010 that appeared to be inconsistent with four national policies and therefore improper. We also found more than $100 million in payments that were inconsistent with three selected LCDs that could have been identified using automated edits. Thus we concluded that more widespread implementation of effective automated edits developed by individual Medicare administrative contractors (MAC) in other MAC jurisdictions could also result in savings to Medicare. |
2,271 | CMS has taken steps to improve the development of other types of prepayment edits that are implemented nationwide, as we recommended. For example, the agency has centralized the development and implementation of automated edits based on a type of national policy called national coverage determinations. CMS has also modified its processes for identifying provider billing of services that are medically unlikely to prevent circumvention of automated edits designed to identify an unusually large quantity of ser |
2,272 | vices provided to the same patient. We also evaluated the implementation of CMS’s Fraud Prevention System (FPS), which uses predictive analytic technologies as required by the Small Business Jobs Act of 2010 to analyze Medicare fee-for-service (FFS) claims on a prepayment basis. FPS identifies investigative leads for CMS’s Zone Program Integrity Contractors (ZPIC), the contractors responsible for detecting and investigating potential fraud. Implemented in July 2011, FPS is intended to help facilitate the ag |
2,273 | ency’s shift from focusing on recovering potentially fraudulent payments after they have been made, to detecting aberrant billing patterns as quickly as possible, with the goal of preventing these payments from being made. However, in October 2012, we found that, while FPS generated leads for investigators, it was not integrated with Medicare’s payment-processing system to allow the prevention of payments until suspect claims can be determined to be valid. As of April 2014, CMS reported that while the FPS f |
2,274 | unctionality to deny claims before payment had been integrated with the Medicare payment processing system in October 2013, the system did not have the ability to suspend payment until suspect claims could be investigated. In addition, while CMS directed the ZPICs to prioritize alerts generated by the system, in our work examining the sources of new ZPIC investigations in 2012, we found that FPS accounted for about 5 percent of ZPIC investigations in that year. A CMS official reported last month that ZPICs |
2,275 | are now using FPS as a primary source of leads for fraud investigations, though the official did not provide details on how much of ZPICs’ work is initiated through the system. Our prior work found that postpayment reviews are critical to identifying and recouping overpayments. The use of national recovery audit contractors (RAC) in the Medicare program is helping to identify underpayments and overpayments on a postpayment basis. CMS began the program in March 2009 for Medicare FFS. CMS reported that, as of |
2,276 | the end of 2013, RACs collected $816 million for fiscal year 2014. PPACA required the expansion of Medicare RACs to Parts C and D. CMS has implemented a RAC for Part D, and CMS said it plans to award a contract for a Part C RAC by the end of 2014. Moreover, in February 2014, CMS announced a “pause” in the RAC program as the agency makes changes to the program and starts a new procurement process for the next round of recovery audit contracts for Medicare FFS claims. CMS said it anticipates awarding all fiv |
2,277 | e of these new Medicare FFS recovery audit contracts by the end of summer 2014. Other contractors help CMS investigate potentially fraudulent FFS payments, but CMS could improve its oversight of their work. CMS contracts with ZPICs in specific geographic zones covering the nation. We recently found that the ZPICs reported that their actions, such as stopping payments on suspect claims, resulted in more than $250 million in savings to Medicare in calendar year 2012. However, CMS lacks information on the time |
2,278 | liness of ZPICs’ actions—such as the time it takes between identifying a suspect provider and taking actions to stop that provider from receiving potentially fraudulent Medicare payments—and would benefit from knowing whether ZPICs could save more money by acting more quickly. Thus, in October 2013, we recommended that CMS collect and evaluate information on the timeliness of ZPICs’ investigative and administrative actions. CMS did not comment on our recommendation. We are currently examining the activities |
2,279 | of the CMS contractors, including ZPICs, that conduct postpayment claims reviews. Our work is reviewing, among other things, whether CMS has a strategy for coordinating these contractors’ postpayment claims review activities. CMS has taken steps to improve use of two CMS information technology systems that could help analysts identify fraud after claims have been paid, but further action is needed. In 2011, we found that the Integrated Data Repository (IDR)—a central data store of Medicare and other data n |
2,280 | eeded to help CMS program integrity staff and contractors detect improper payments of claims—did not include all the data that were planned to be incorporated by fiscal year 2010, because of technical obstacles and delays in funding. As of March 2014, the agency had not addressed our recommendation to develop reliable schedules to incorporate all types of IDR data, which could lead to additional delays in making available all of the data that are needed to support enhanced program integrity efforts and achi |
2,281 | eve the expected financial benefits. However, One Program Integrity (One PI)—a web-based portal intended to provide CMS staff and contractors with a single source of access to data contained in IDR, as well as tools for analyzing those data—is operational and CMS has established plans and schedules for training all intended One PI users, as we also recommended in 2011. However, as of March 2014, CMS had not established deadlines for program integrity contractors to begin using One PI, as we recommended in 2 |
2,282 | 011. Without these deadlines, program integrity contractors will not be required to use the system, and as a result, CMS may fall short in its efforts to ensure the widespread use and to measure the benefits of One PI for program integrity purposes. Having mechanisms in place to resolve vulnerabilities that could lead to improper payments, some of which are potentially fraudulent, is critical to effective program management, but our work has shown weaknesses in CMS’s processes to address such vulnerabilitie |
2,283 | s. Both we and OIG have made recommendations to CMS to improve the tracking of vulnerabilities. In our March 2010 report on the RAC demonstration program, we found that CMS had not established an adequate process during the demonstration or in planning for the national program to ensure prompt resolution of vulnerabilities that could lead to improper payments in Medicare; further, the majority of the most significant vulnerabilities identified during the demonstration were not addressed. In December 2011, O |
2,284 | IG found that CMS had not resolved or taken significant action to resolve 48 of 62 vulnerabilities reported in 2009 by CMS contractors specifically charged with addressing fraud. We and OIG recommended that CMS have written procedures and time frames to ensure that vulnerabilities were resolved. CMS has indicated that it is now tracking vulnerabilities identified from several types of contractors through a single vulnerability tracking process, and the agency has developed some written guidance on the proce |
2,285 | ss. We recently examined that process and found that, while CMS informs MACs about vulnerabilities that could be addressed through prepayment edits, the agency does not systematically compile and disseminate information about effective local edits to address such vulnerabilities. Specifically, we recommended that CMS require MACs to share information about the underlying policies and savings related to their most effective edits, and CMS generally agreed to do so. In addition, in 2011, CMS began requiring M |
2,286 | ACs to report on how they had addressed certain vulnerabilities to improper payment, some of which could be addressed through edits. We also recently made recommendations to CMS to address the millions of Medicare cards that display beneficiaries’ Social Security numbers, In August which increases beneficiaries’ vulnerability to identity theft.2012, we recommended that CMS (1) select an approach for removing Social Security numbers from Medicare cards that best protects beneficiaries from identity theft and |
2,287 | minimizes burdens for providers, beneficiaries, and CMS and (2) develop an accurate, well-documented cost estimate for such an option. In September 2013, we further recommended that CMS (1) initiate an information technology project for identifying, developing, and implementing changes for the removal of Social Security numbers and (2) incorporate such a project into other information technology initiatives. HHS concurred with our recommendations and agreed that removing the numbers from Medicare cards is |
2,288 | an appropriate step toward reducing the risk of identity theft. However, the department also said that CMS could not proceed with changes without agreement from other agencies, such as the Social Security Administration, and that funding was also a consideration. Thus, CMS has not yet taken action to address these recommendations. We are currently examining other options for updating and securing Medicare cards, including the potential use of electronic-card technologies. In addition, we and others have ide |
2,289 | ntified concerns with CMS oversight of fraud, waste, and abuse in Medicare’s prescription drug program, Part D, including the contractors tasked with this work. To help address potential vulnerabilities in that program, we are examining practices for promoting prescription drug program integrity, and the extent to which CMS’s oversight of Medicare Part D reflects those practices. Although CMS has taken some important steps to identify and prevent fraud, the agency must continue to improve its efforts to red |
2,290 | uce fraud, waste, and abuse in the Medicare program. Identifying the nature, extent, and underlying causes of improper payments, and developing adequate corrective action processes to address vulnerabilities, are essential prerequisites to reducing them. As CMS continues its implementation of PPACA and Small Business Jobs Act provisions, additional evaluation and oversight will help determine whether implementation of these provisions has been effective in reducing improper payments. We are investing resour |
2,291 | ces in a body of work that assesses CMS’s efforts to refine and improve its fraud detection and prevention abilities. Notably, we are currently assessing the potential use of electronic-card technologies, which can help reduce Medicare fraud. We are also examining the extent to which CMS’s information system can help prevent and detect the continued enrollment of ineligible or potentially fraudulent providers in Medicare. Additionally, we have a study underway examining CMS’s oversight of fraud, waste, and |
2,292 | abuse in Medicare Part D to determine whether the agency has adopted certain practices for ensuring the integrity of that program. We are also examining CMS’s oversight of some of the contractors that conduct reviews of claims after payment. These studies are focused on additional actions for CMS that could help the agency more systematically reduce potential fraud in the Medicare program. Chairman Brady, Ranking Member McDermott, and Members of the Subcommittee, this concludes my prepared remarks. I would |
2,293 | be pleased to respond to any questions you may have at this time. For further information about this statement, please contact Kathleen M. King at (202) 512-7114 or [email protected]. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this statement. Karen Doran, Assistant Director; Stephen Robblee; Lisa Rogers; Eden Savino; and Jennifer Whitworth were key contributors to this statement. Medicare: Second Year Update for CMS’s Durable Medical Equipment C |
2,294 | ompetitive Bidding Program Round 1 Rebid. GAO-14-156. Washington, D.C.: March 7, 2014. Medicare Program Integrity: Contractors Reported Generating Savings, but CMS Could Improve Its Oversight. GAO-14-111. Washington, D.C.: October 25, 2013. Medicare Information Technology: Centers for Medicare and Medicaid Services Needs to Pursue a Solution for Removing Social Security Numbers from Cards. GAO-13-761. Washington, D.C.: September 10, 2013 Health Care Fraud and Abuse Control Program: Indicators Provide Inform |
2,295 | ation on Program Accomplishments, but Assessing Program Effectiveness Is Difficult. GAO-13-746. Washington, D.C.: September 30, 2013. Medicare Program Integrity: Increasing Consistency of Contractor Requirements May Improve Administrative Efficiency. GAO-13-522. Washington, D.C.: July 23, 2013. Medicare Program Integrity: Few Payments in 2011 Exceeded Limits under One Kind of Prepayment Control, but Reassessing Limits Could Be Helpful. GAO-13-430. Washington, D.C.: May 9, 2013. 2013 Annual Report: Actions N |
2,296 | eeded to Reduce Fragmentation, Overlap, and Duplication and Achieve Other Financial Benefits. GAO-13-279SP. Washington, D.C.: April 9, 2013. Medicare Fraud Prevention: CMS Has Implemented a Predictive Analytics System, but Needs to Define Measures to Determine Its Effectiveness. GAO-13-104. Washington, D.C.: October 15, 2012. Medicare Program Integrity: Greater Prepayment Control Efforts Could Increase Savings and Better Ensure Proper Payment. GAO-13-102. Washington, D.C.: November 13, 2012. Medicare: CMS N |
2,297 | eeds an Approach and a Reliable Cost Estimate for Removing Social Security Numbers from Medicare Cards. GAO-12-831. Washington, D.C.: August 1, 2012. Health Care Fraud: Types of Providers Involved in Medicare, Medicaid, and the Children’s Health Insurance Program Cases. GAO-12-820. Washington, D.C.: September 7, 2012. Program Integrity: Further Action Needed to Address Vulnerabilities in Medicaid and Medicare Programs. GAO-12-803T. Washington, D.C.: June 7, 2012. Follow-up on 2011 Report: Status of Actions |
2,298 | Taken to Reduce Duplication, Overlap, and Fragmentation, Save Tax Dollars, and Enhance Revenue. GAO-12-453SP. Washington, D.C.: February 28, 2012. Medicare: The First Year of the Durable Medical Equipment Competitive Bidding Program Round 1 Rebid. GAO-12-733T. Washington, D.C.: May 9, 2012. Medicare: Review of the First Year of CMS’s Durable Medical Equipment Competitive Bidding Program’s Round 1 Rebid. GAO-12-693. Washington, D.C.: May 9, 2012. Medicare: Important Steps Have Been Taken, but More Could Be D |
2,299 | one to Deter Fraud. GAO-12-671T. Washington, D.C.: April 24, 2012. Medicare Program Integrity: CMS Continues Efforts to Strengthen the Screening of Providers and Suppliers. GAO-12-351. Washington, D.C.: April 10, 2012. Improper Payments: Remaining Challenges and Strategies for Governmentwide Reduction Efforts. GAO-12-573T. Washington, D.C.: March 28, 2012. 2012 Annual Report: Opportunities to Reduce Duplication, Overlap and Fragmentation, Achieve Savings, and Enhance Revenue. GAO-12-342SP. Washington, D.C.: |
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