Medicare Advantage: Required Audits of Limited Value (16-OCT-07, 
GAO-08-154T).							 
                                                                 
In fiscal year 2006, the Centers for Medicare & Medicaid Services
(CMS) estimated it spent over $51 billion on the Medicare	 
Advantage program, which serves as an alternative to the	 
traditional feefor- service program. Under the Medicare Advantage
program, CMS approves private companies to offer health plan	 
options to Medicare enrollees that include all Medicare-covered  
services. Many plans also provide supplemental benefits. The	 
Balanced Budget Act (BBA) of 1997 requires CMS to annually audit 
the financial records supporting the submissions (i.e., adjusted 
community rate proposals (ACRP) or bids) of at least onethird of 
participating organizations. BBA also requires that GAO monitor  
the audits. This testimony provides information on (1) the ACRP  
and bid process and related audit requirement, (2) CMS' efforts  
related to complying with the audit requirement, and (3) factors 
that cause CMS' audit process to be of limited value.		 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-08-154T					        
    ACCNO:   A77371						        
  TITLE:     Medicare Advantage: Required Audits of Limited Value     
     DATE:   10/16/2007 
  SUBJECT:   Accountability					 
	     Audit reports					 
	     Auditing procedures				 
	     Corporate audits					 
	     Financial analysis 				 
	     Financial records					 
	     Financial statement audits 			 
	     Financial statements				 
	     Health care programs				 
	     Internal controls					 
	     Medicare						 
	     Reporting requirements				 
	     Medicare Advantage Program 			 

******************************************************************
** This file contains an ASCII representation of the text of a  **
** GAO Product.                                                 **
**                                                              **
** No attempt has been made to display graphic images, although **
** figure captions are reproduced.  Tables are included, but    **
** may not resemble those in the printed version.               **
**                                                              **
** Please see the PDF (Portable Document Format) file, when     **
** available, for a complete electronic file of the printed     **
** document's contents.                                         **
**                                                              **
******************************************************************
GAO-08-154T

   

     * [1]Medicare Advantage ACRP and Bid Process and Related Audit Re
     * [2]GAO Analysis Shows CMS Did Not Meet the Audit Requirement
     * [3]CMS' Audit Process Was of Limited Value
     * [4]Concluding Remarks
     * [5]Contacts and Acknowledgments
     * [6]GAO's Mission
     * [7]Obtaining Copies of GAO Reports and Testimony

          * [8]Order by Mail or Phone

     * [9]To Report Fraud, Waste, and Abuse in Federal Programs
     * [10]Congressional Relations
     * [11]Public Affairs

                 United States Government Accountability Office

Testimony

GAO

 Before the Subcommittees on Health and Oversight, Committee on Ways and Means,
                            House of Representatives

For Release on Delivery       MEDICARE ADVANTAGE                           
Expected at 10:00 a.m. EST                                                 
Tuesday, October 16, 2007                                                  
                                 Required Audits of Limited Value             
                                 
											Statement of:                                
                                 Jeffrey C. Steinhoff, Managing Director,     
                                 Financial Management and Assurance           
                                 
											and                                          
                                 James Cosgrove, Acting Director, Health Care 
                                 
											Accompanied by:                              
                                 Kimberly Brooks, Assistant Director,         
                                 Financial Management and Assurance           

GAO-08-154T

MEDICARE ADVANTAGE

  Required Audits of Limited Value

    What GAO Found

Before 2006, companies choosing to participate in the Medicare Advantage
program were annually required to submit an ACRP to CMS for review and
approval. In 2006, a bid submission process replaced the ACRP process. The
ACRPs and bids identify the health services the company will provide to
Medicare members and the estimated cost for providing those services. CMS
contracted with accounting and actuarial firms to perform the required
audits.

According to our analysis, CMS did not meet the requirement for auditing
the financial records of at least one-third of the participating Medicare
Advantage organizations for contract years 2001-2005. CMS is planning to
conduct other financial reviews of organizations to meet the audit
requirement for contract year 2006. However, CMS does not plan to complete
the financial reviews until almost 3 years after the bid submission date
each contract year, which will affect its ability to address any
identified deficiencies in a timely manner.

CMS did not consistently ensure that the audit process for contract years
2001-2005 provided information to assess the impact on beneficiaries.
After contract year 2003 audits were completed, CMS took steps to
determine such impact and identified an impact on beneficiaries of about
$35 million. CMS audited contract year 2006 bids for 80 organizations, and
18 had a material finding that affected amounts in approved bids. CMS
officials took limited action to follow up on contract year 2006 findings.
CMS officials told us they do not plan to sanction or pursue financial
recoveries based on these audits because the agency does not have the
legal authority to do so. According to our assessment of the statutes, CMS
had the authority to pursue financial recoveries, but its rights under
contracts for 2001-2005 were limited because its implementing regulations
did not require that each contract include provisions to inform
organizations about the audits and about the steps that CMS would take to
address identified deficiencies. Further, our assessment of the statute is
that CMS has the authority to include terms in bid contracts that would
allow it to pursue financial recoveries. Without changes in its
procedures, CMS will continue to invest resources in audits that will
likely provide limited value.

                 United States Government Accountability Office

Mr. Chairmen and Members of the Subcommittees:

We are pleased to be here today to testify on the results of our review of
the Centers for Medicare & Medicaid Services' (CMS) audit activities
related to Medicare Advantage (MA) organizations that was mandated by the
Balanced Budget Act (BBA) of 1997. ^[12]1 Our results are documented in
our July report, Medicare Advantage: Required Audits of Limited Value. BBA
requires CMS to annually audit the financial records (including data
relating to Medicare utilization and costs) of at least one-third of the
organizations participating in the Medicare Advantage program. BBA also
requires us to monitor CMS' audit activities.

In fiscal year 2006, CMS estimated it spent over $51 billion on the
Medicare Advantage program, ^[13]3 which serves as an alternative to
Medicare's traditional fee-for-service program. Under Medicare Advantage,
CMS approves private companies to offer health plan options that include
all Medicare-covered services. In addition, many plans provide
supplemental benefits, such as a reduction in the enrollee's required cost
sharing (e.g., beneficiaries' Part B premiums) ^[14]4 or coverage for
items and services not included under the traditional fee-for-service
program, such as dental care. According to CMS, in fiscal year 2006, over
16 percent of Medicare beneficiaries--or about 7 million of the
approximately 43 million--were enrolled in a Medicare Advantage plan.

Our review covered CMS audits for contract years 2001 through 2006. In
summary, we found that the required audits were of limited value, which is
similar to what we reported on audits for contract year 2000 in October
2001, when we last reviewed CMS' audit activities under BBA. ^[15]5 The
findings in our latest review cause us continuing concern about the audit
process. CMS did not document its process to determine whether it met
the requirement to audit the financial records of at least one-third of
the participating organizations for contract years 2001 through 2006, and
based on our analysis of available CMS data, CMS did not meet that
requirement. For those audits that CMS completed, it did not consistently
ensure that the audit process provided information needed for assessing
the potential impact on beneficiaries, and CMS took limited action to
follow-up on the audit findings.

^1Pub. L. No. 105-33,  tit. IV, S  4001, 111 Stat. 251,  320 (Aug. 5,  1997)
(codified at 42 U.S.C. S 1395w-27(d)(1)).

^2GAO, Medicare Advantage:  Required Audits of  Limited Value,  GAO-07-945
(Washington, D.C.: July 30, 2007).

^3Total Medicare outlays in fiscal year 2006 were $381.9 billion.

^4Medicare Part  B  provides  coverage  for  certain  physician,  outpatient
hospital, laboratory, and other services to beneficiaries who pay  monthly
premiums.

^5GAO, Medicare+Choice Audits:  Lack of Audit  Follow-up Limits  Usefulness,
GAO-02-33 (Washington, D.C.: October 9, 2001).

Today, we will discuss the findings in our recent report. Specifically, we
will tell you about:

     o the adjusted community rate proposal (ACRP) and bid process and the
       related audit requirement for organizations that participate in the
       Medicare Advantage program,
     o CMS' efforts to comply with the audit requirement for organizations'
       ACRP and bid submissions, and
     o factors that cause CMS' audit process to be of limited value.

Our prior work on which this testimony is based was performed in
accordance with generally accepted government auditing standards.

Medicare Advantage ACRP and Bid Process and Related Audit Requirements

Before 2006, companies choosing to participate in the Medicare Advantage
program were required to annually submit an ACRP to CMS for review and
approval for each plan they intended to offer. ^[16]6 The ACRP consisted
of two parts--a plan benefit package and the adjusted community rate
(ACR). The plan benefit package contained a detailed description of the
benefits offered, and the ACR contained a detailed description of the
estimated costs to provide the package of benefits to an enrolled Medicare
beneficiary. These costs were to be calculated based on how much a plan
would charge a commercial customer to provide the same benefit package if
its members had the same expected use of services as Medicare
beneficiaries. CMS made payments to the companies monthly in advance of
rendering services.

In 2003, Congress enacted the Medicare Prescription Drug, Improvement and
Modernization Act of 2003 (MMA). ^[17]7 MMA included provisions that
established a bid submission process to replace the ACRP submission
process, as well as a new prescription drug benefit, both effective for
2006. Under the bid process, an organization choosing to participate in
Medicare Advantage is required to annually submit a bid for review and
approval for each plan they intend to offer. The bid submission includes
the organization's estimate of the cost of delivering services (submitted
on a bid form) to an enrolled Medicare beneficiary and a plan benefit
package that provides a detailed description of the benefits offered. In
addition, each MA organization and prescription drug plan that offers
prescription drug benefits under Part D ^[18]8 is required to submit a
separate prescription drug bid form, a formulary, ^[19]9 and a plan
benefit package to CMS for its review and approval. On the bid forms, MA
organizations include an estimate of the per-person cost of providing
Medicare-covered services.

^6Participating companies or  sponsors can  offer multiple  plans. The  term
"plan" refers to a specific package of benefits offered.

^7Pub. L. No. 108-173, 117 Stat. 2066 (Dec. 8, 2003).

BBA requires CMS to annually audit the submissions of one-third of MA
organizations. In defining what constituted an organization for the
purpose of selecting one-third for audit, CMS officials explained that
they determined the number of participating organizations based on the
number of contracts they awarded. Under each contract, an organization can
offer multiple plans. Further, an organization like Humana Inc. can have
multiple contracts.

CMS contracts with accounting and actuarial firms to perform these audits.
For audits of the contract year 2006 bid forms, CMS contracted in
September 2005 with six firms. CMS gave the auditors guidance. It is
important to note that the audit guidance includes procedures to verify
information used in the projection or estimation of costs submitted in the
bids, not actual results or costs each year, as the bids do not report
actual costs.

^8Part D is the optional outpatient prescription drug benefit for Medicare
established by MMA.

^9The formulary is a listing of prescription medications that are approved
for use or coverage by the plan and that will be dispensed through
participating pharmacies to covered enrollees.

GAO Analysis Shows CMS Did Not Meet the Audit Requirement

According to our analysis of available CMS data, CMS did not meet the
statutory requirement to audit the financial records of at least one-third
of the participating MA organizations for contract years 2001 through
2005, nor has it done so yet for the 2006 bid submissions. We performed an
analysis to determine whether CMS had met the requirement because CMS
could not provide documentation to support the method it used to select
the ACRs and bids for audit, nor did CMS document whether or how it met
the one-third requirement for contract years 2001 through 2006. Our
analysis shows that between 18.6 and 23.6 percent, or fewer than onethird,
of the MA organizations (as defined by the number of contracts each year)
for contract years 2001 through 2005 were audited each year. Similarly, we
determined that only 13.9 percent of the MA organizations and prescription
drug plans with approved bids for 2006 were audited, as of the end of our
review. ^[20]10 Table 1 summarizes our results.

Table 1: Summary of MA Organizations  Audited as a Percentage of Total  MA
Organizations and Audit Costs

Contract year: 2001; 
Type of audit: ACRP; 
Number of organizations audited[A]: 50; 
Number of organizations: 212; 
Percentage of organizations audited: 23.6; 
Audit costs[B] (dollars in millions): $2.8. 

Contract year: 2002; 
Type of audit: ACRP; 
Number of organizations audited[A]: 40; 
Number of organizations: 183; 
Percentage of organizations audited: 21.9; 
Audit costs[B] (dollars in millions): $2.6. 

Contract year: 2003; 
Type of audit: ACRP; 
Number of organizations audited[A]: 49; 
Number of organizations: 220; 
Percentage of organizations audited: 22.3; 
Audit costs[B] (dollars in millions): $3.8. 

Contract year: 2004; 
Type of audit: ACRP; 
Number of organizations audited[A]: 47; 
Number of organizations: 228; 
Percentage of organizations audited: 20.6; 
Audit costs[B] (dollars in millions): $3.4. 

Contract year: 2005; 
Type of audit: ACRP; 
Number of organizations audited[A]: 59; 
Number of organizations: 318; 
Percentage of organizations audited: 18.6; 
Audit costs[B] (dollars in millions): $2.6. 

Contract year: 2006; 
Type of audit: Bid; 
Number of organizations audited[A]: 80; 
Number of organizations: 577; 
Percentage of organizations audited: 13.9; 
Audit costs[B] (dollars in millions): $3.3. 

Source: GAO analysis of CMS data and ACRP and bid audit reports.

[a]In determining what constituted an organization for audit purposes, CMS
determined the number of organizations based on the contract level.
Several plans may be offered under one contract.

[b]Audit costs include only amounts awarded to audit contractors and do not
include CMS staff costs.

As stated earlier, CMS selects organizations to meet the one-third audit
requirement based on the number of contracts awarded and not the total
number of plans offered under each contract. However, to present
additional perspective, we also analyzed the percentage of plans audited
of the total number of plans offered by each audited organization. Our
analysis shows that with the exception of contract year 2002, the level of
audit coverage achieved by CMS audits has progressively decreased in terms
of the percentage of plans audited for those organizations that were
audited. Audit coverage has also decreased in terms of the percentage of
plans audited of all plans offered by participating organizations each
contract year. In contract year 2006, a large increase in the number of
bid submissions meant that the 159 plans audited reflected only 3.2
percent of all the plans offered. Table 2 summarizes our analysis.

^10The 80  organizations  audited  for  contract year  2006  included  60  MA
organizations with prescription drug plans and 20 prescription drug plans.

Table 2: Summary  of Audited  Plans as a  Percentage of  Those Offered  by
Audited Organizations and All Participating Organizations

Contract year: 2001; 
Type of audit: ACRP; 
Number of plans audited for audited organizations: 165; 
Number of plans offered by audited organizations: 216; 
Percentage of plans audited of all plans offered by audited 
organizations: 76.4; 
Number of plans offered by all participating organizations: 743; 
Percentage of plans audited of all plans offered by participating 
organizations: 22.2. 

Contract year: 2002; 
Type of audit: ACRP; 
Number of plans audited for audited organizations: 84; 
Number of plans offered by audited organizations: 93; 
Percentage of plans audited of all plans offered by audited 
organizations: 90.3; 
Number of plans offered by all participating organizations: 554; 
Percentage of plans audited of all plans offered by participating 
organizations: 15.2. 

Contract year: 2003; 
Type of audit: ACRP; 
Number of plans audited for audited organizations: 137; 
Number of plans offered by audited organizations: 254; 
Percentage of plans audited of all plans offered by audited 
organizations: 53.9; 
Number of plans offered by all participating organizations: 770; 
Percentage of plans audited of all plans offered by participating 
organizations: 17.8. 

Contract year: 2004; 
Type of audit: ACRP; 
Number of plans audited for audited organizations: 124; 
Number of plans offered by audited organizations: 257; 
Percentage of plans audited of all plans offered by audited 
organizations: 48.2; 
Number of plans offered by all participating organizations: 967; 
Percentage of plans audited of all plans offered by participating 
organizations: 12.8. 

Contract year: 2005; 
Type of audit: ACRP; 
Number of plans audited for audited organizations: 100; 
Number of plans offered by audited organizations: 476; 
Percentage of plans audited of all plans offered by audited 
organizations: 21.0; 
Number of plans offered by all participating organizations: 1,865; 
Percentage of plans audited of all plans offered by participating 
organizations: 5.3. 

Contract year: 2006; 
Type of audit: Bid; 
Number of plans audited for audited organizations: 159; 
Number of plans offered by audited organizations: 1,194; 
Percentage of plans audited of all plans offered by audited 
organizations: 13.3; 
Number of plans offered by all participating organizations: 4,920; 
Percentage of plans audited of all plans offered by participating 
organizations: 3.2. 

Source: GAO analysis of CMS data and ACRP and bid audit reports.

Regarding contract years 2001 through 2004, CMS officials told us that
they did not know how the MA organizations were selected for audit, and
the documentation supporting the selections was either not created or not
retained. For contract year 2005 audits, CMS officials told us that the
selection criteria included several factors. They said that the criteria
considered included whether the MA organization had been audited
previously and whether it had significant issues.

With respect to contract year 2006, CMS officials acknowledged the
onethird requirement, but they stated that they did not intend for the
audits of the 2006 bid submissions to meet the one-third audit
requirement. They explained that they plan to conduct other reviews of the
financial records of MA organizations and prescription drug plans to meet
the requirement for 2006. In September 2006, CMS hired a contractor to
develop the agency's overall approach to conducting reviews to meet the
one-third requirement. Draft audit procedures prepared by the contractor
in May 2007, indicate that CMS plans to review solvency, risk scores,
related parties, direct medical and administrative costs, and, where
relevant, regional preferred provider organizations' (RPPO) cost
reconciliation reports for MA bids. For Part D bids, CMS indicated it also
plans to review other areas, including beneficiaries' true out-of-pocket
costs. ^[21]11 However, when our review ended, CMS had not yet clearly
laid out how these reviews will be conducted to meet the one-third
requirement. Further, CMS is not likely to complete these other financial
reviews until almost 3 years after the bid submission date (see figure 1)
for each contract year, in part because it must first reconcile payment
data that prescription drug plans are not required to submit to CMS until
6 months after the contract year is over. Such an extended cycle for
conducting these reviews greatly limits their usefulness to CMS and
hinders CMS' ability to recommend and implement timely actions to address
identified deficiencies in the MA organizations' and prescription drug
plans' bid processes.

^11True out-of-pocket costs are amounts paid by the enrollee or on behalf of
the enrollee for covered Part D drugs that count toward the out-of-pocket
limit that must be reached before the catastrophic benefit becomes
available.

  Figure 1: Time Elapsed from Contract Year 2006 Bid Submissions to Reviews to
                             Meet Audit Requirement

                    CMS' Audit Process Was of Limited Value

In its audits for contract years 2001-2005, CMS did not consistently
ensure that the audit process provided information needed for assessing
the potential impact of errors on beneficiaries' benefits or payments to
the MA organizations. The auditors reported findings ranging from lack of
supporting documentation to overstating or understating certain costs, but
did not identify how the errors affected beneficiary benefits, copayments,
or premiums. In addition, although the auditors categorized their results
as findings and observations, with findings being more significant,
depending on their materiality to the average payment rate reported in the
ACR, the distinction between findings and observations, was based on
judgment, and therefore varied among the different auditors. In our 2001
report, we reported that CMS planned to require auditors, where
applicable, to quantify in their audit reports the overall impact of
errors. ^[22]12 Further, during the work for the 2001 report, CMS
officials stated that they were in the process of determining the impact
on beneficiaries and crafting a strategy for audit follow-up and
resolution. CMS did not initiate any actions to attempt to determine such
impact until after the contract year 2003 audits were completed. CMS took
steps to determine such impact and identified a net of about $35 million
from the contract year 2003 audits that beneficiaries could have received
in additional benefits. ^[23]13 The only audit follow-up action that CMS
has taken regarding the ACR audits was to provide copies of the audit
reports to the MA organizations and instruct them to take action in
subsequent ACR filings.

In CMS' audits of the 2006 bid submissions, 18 (or about 23 percent) of
the 80 organizations audited had material findings that have an impact on
beneficiaries or plan payments approved in bids. CMS defined material
findings as those that would result in changes in the total bid amount of
1 percent or more or in the estimate for the costs per member per month of
10 percent or more for any bid element. ^[24]14 CMS officials told us that
they will use the results of the bid audits to help organizations improve
their methods in preparing bids in subsequent years and to help improve
the overall bid process. Specifically, they told us they could improve the
bid forms, bid instructions, training, and bid review process.

CMS' audit follow-up process has not involved pursuing financial
recoveries from Medicare Advantage organizations based on audit results
even when information was available on deficiencies or errors that could
impact beneficiaries. CMS officials told us they do not plan to pursue
financial recoveries from MA organizations based on the results of ACR or
bid audits because the agency does not have the legal authority to do so.
According to our assessment of the statutes, CMS has the authority to
pursue financial recoveries, but its rights under contracts for 2001
through 2005 are limited because its implementing regulations did not
require that each contract include provisions to inform organizations
about the audits and about the steps that CMS would take to address
identified deficiencies, including pursuit of financial recoveries.
Regarding the bid process that began in 2006, our assessment of the
statutes is that CMS has the authority to include terms in bid contracts
that would allow it to pursue financial recoveries based on bid audit
results. ^[25]15 CMS also has the authority to sanction organizations, but
it has not.

^12GAO-02-33, p. 20.

^13Information on the impact of errors identified in contract year 2004 and
contract year 2005 audits was not completed or not available at the time
we completed our recent review.

^14Findings also include any serious failure to follow applicable Actuarial
Standards of Practice. Materiality for identifying observations included
all other errors or deviations from the instructions or best actuarial
practices that did not meet the criteria for being classified as findings.

CMS officials believe the bid audits provide a "sentinel or deterrent
effect" for organizations to properly prepare their bids because they do
not know when the bids may be selected for a detailed audit. Given the
current audit coverage, CMS is unlikely to achieve significant deterrent
effect, however, because only 13.9 percent of participating organizations
for contract 2006 have been audited.

                               Concluding Remarks

Appropriate oversight and accountability mechanisms are key to protecting
the federal government's interests in using taxpayer resources prudently.
When CMS falls short in meeting the statutory audit requirements and in a
timely manner resolving the findings arising from those audits, the
intended oversight is not achieved and opportunities are lost to determine
whether organizations have reasonably estimated the costs to provide
benefits to Medicare enrollees. Inaction or untimely audit resolution also
undermines the presumed deterrent effect of audit efforts.

While the statutory audit requirement does not expressly state the
objective of the audits or how CMS should address the results of the
audits, the statute does not preclude CMS from including terms in its
contracts that allow it to pursue financial recoveries based on audit
results. If CMS maintains the view that statute does not allow it to take
certain actions, the utility of CMS' efforts is of limited value.

In our recent report, we made several recommendations to the CMS
Administrator to improve processes and procedures related to its meeting
the one-third audit requirement and audit follow-up. We also recommended
that CMS amend its implementing regulations for the
Medicare Advantage Program and Prescription Drug Program to provide that
all contracts CMS enters into with MA organizations and prescription drug
plan sponsors include terms that inform these organizations of the audits
and give CMS authority to address identified deficiencies, including
pursuit of financial recoveries. We further recommended that if CMS does
not believe it has the authority to amend its implementing regulations for
these purposes, it should ask Congress for express authority to do so. In
response to our report, CMS concurred with our recommendations and stated
it is in the process of implementing some of our recommendations.

^1542 U.S.C. S 1395w-27(e)(1);  42 C.F.R. S  422.504(j). This provision  also
applies  to  prescription   drug  plans   under  Part  D.   42  U.S.C.   S
1395w-112(b)(3)(D).

Contacts and Acknowledgments

For information about this statement, please contact Jeanette Franzel,
Director, Financial Management and Assurance, at (202) 512-9471 or
[26][email protected] or James Cosgrove, Acting Director, Health Care, at
(202) 512-7029 or [27][email protected]. Individuals who made key
contributions to this testimony include Kimberly Brooks (Assistant
Director), Christine Brudevold, Paul Caban, Abe Dymond, Jason Kirwan, and
Diane Morris.

  (194741)

This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed in
its entirety without further permission from GAO. However, because this
work may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this material
separately.

GAO's Mission

The Government Accountability Office, the audit, evaluation, and
investigative arm of Congress, exists to support Congress in meeting its
constitutional responsibilities and to help improve the performance and
accountability of the federal government for the American people. GAO
examines the use of public funds; evaluates federal programs and policies;
and provides analyses, recommendations, and other assistance to help
Congress make informed oversight, policy, and funding decisions. GAO's
commitment to good government is reflected in its core values of
accountability, integrity, and reliability.

The fastest and easiest way to obtain copies of GAO documents at no cost
is through GAO's Web site ( [28]www.gao.gov) . Each weekday, GAO posts GAO
Reports and newly released reports, testimony, and correspondence on its
Web site. To

have GAO e-mail you a list of newly posted products every afternoon, go to
[29]www.gao.gov and select "E-mail Updates."

                             Order by Mail or Phone

The first copy of each printed report is free. Additional copies are $2
each. A check or money order should be made out to the Superintendent of
Documents. GAO also accepts VISA and Mastercard. Orders for 100 or more
copies mailed to a single address are discounted 25 percent. Orders should
be sent to:

U.S. Government Accountability Office 441 G Street NW, Room LM Washington,
DC 20548

To order by Phone:
Voice: (202) 512-6000
TDD: (202) 512-2537
Fax: (202) 512-6061

To Report Fraud, Waste, and Abuse in Federal Programs

Contact:

Web site: [30]www.gao.gov/fraudnet/fraudnet.htm
E-mail: [31][email protected]
Federal Programs Automated answering system: (800) 424-5454 or (202)
512-7470

Gloria Jarmon, Managing Director, [32][email protected], (202) 512-4400 U.S.
Government Accountability Office, 441 G Street NW, Room 7125 Relations
Washington, DC 20548

Susan Becker, Acting Manager, [33][email protected], (202) 512-4800

Public Affairs

U.S.  Government  Accountability  Office,  441  G  Street  NW,  Room  7149
Washington, DC 20548

References

Visible links
  26. fmailto:[email protected]
  27. fmailto:[email protected]
  28. http://www.gao.gov/
  29. http://www.gao.gov/
  30. http://www.gao.gov/fraudnet/fraudnet.htm
  31. fmailto:[email protected]
  32. fmailto:[email protected]
  33. fmailto:[email protected]
*** End of document. ***