GAO: VA and Medicare Advantage Improper Payments Expose Risk Gaps
GAO found unfinished fraud-risk work at VA and CMS, including delayed Medicare Advantage RADV audits. The reported improper-payment figures are not fraud estimates.
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TL;DR:
GAO found unfinished fraud-risk work at VA and CMS, including delayed Medicare Advantage audits. The reported improper-payment figures are not fraud estimates.
GAO found unfinished fraud-risk work at VA and CMS, including delayed Medicare Advantage audits. The reported improper-payment figures are not fraud estimates.
What you need to know
- The change: GAO recommended comprehensive fraud-risk assessments for VA Community Care and Medicare Advantage, plus a detailed CMS plan for expediting RADV audits.
- Who is affected: VA and CMS program leaders, Medicare Advantage organizations, contractors, healthcare compliance teams, and internal auditors.
- Why it matters: VA reported approximately $608 million in fiscal year 2025 Community Care improper payments. CMS reported approximately $23.7 billion for Medicare Advantage. These are improper-payment estimates, not estimates of fraud.
- What to do first: Separate administrative errors, unsupported payments, recoverable overpayments, and suspected fraud in management reporting.
- Key date or trigger: GAO publicly released report GAO-26-107946 on July 21, 2026.
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