A letter report issued by the Government Accountability Office with an abstract that begins "The Centers for Medicare & Medicaid Services' (CMS) contractors that conduct postpayment reviews on Medicare fee-for-service (FFS) claims were established by different legislative actions; are managed by different offices within CMS; and serve different functions in the program. These contractors include (1) Medicare Administrative Contractors that process and pay claims and are responsible for taking actions to reduce payment errors in their jurisdictions; (2) Zone Program Integrity Contractors (ZPIC) that investigate potential fraud, which can result in referrals to law enforcement or administrative actions; (3) Recovery Auditors (RA) tasked to identify improper payments on a postpayment basis; and (4) the Comprehensive Error Rate Testing (CERT) contractor that reviews a sample of claims nationwide and related documentation to determine a national Medicare FFS improper payment rate. All four types of contractors conduct complex reviews, in which the contractor examines medical records and other documentation sent by providers to determine if the claims meet Medicare coverage and payment requirements. RAs are paid fees contingent on the amount of the claims that are found improper and recouped or adjusted, whereas the other contractors' reimbursement is not dependent on the …

Correspondence issued by the Government Accountability Office with an abstract that begins "GAO reported the range of base premiums prior to underwriting for health insurance in the individual market that were displayed on the HealthCare.gov Plan Finder in the month of January 2013 for each of the 50 states and the District of Columbia. The base premiums displayed on the HealthCare.gov Plan Finder reflected information from data submitted by insurers to the Center for Consumer Information and Insurance Oversight (CCIIO) within the Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS). Included were ranges for six different types of consumers: 1) 30-year-old, single, nonsmoking male; 2) 30-year-old, single, smoking male; 3) 30-year-old, single, nonsmoking female; 4) 30-year-old, single, smoking female; 5) a family of 4 with 2 parents, aged 40; and 6) a couple, aged 55. GAO also reported on base premiums prior to underwriting for an urban and rural zip code in four select states, one from each census region. The states included: Illinois, Nevada, Pennsylvania, and Texas."