Federal Reports

The Centers for Medicare & Medicaid Services (CMS) oversees implementation of health insurance provisions for the Affordable Care Act and works with States to establish marketplaces, which evaluate individuals' eligibility for qualified health plans (QHPs) and insurance affordability programs (i.e., the premium tax credit and cost-sharing reductions). Our prior reviews of seven State marketplaces found that not all of their internal controls were effective in ensuring that individuals were properly determined eligible for QHPs and insurance affordability programs. These deficiencies led us to review the effectiveness of CMS's oversight of State marketplaces. Our objective was to determine whether CMS provided effective oversight to ensure that State marketplaces determined individuals' eligibility for QHPs and insurance affordability programs according to Federal requirements.

This is our final audit report on the awarding of U.S. Census Bureau (the Bureau) noncompetitive contracts. Our objective was to determine whether the Bureau’s contracting personnel properly awarded noncompetitive contracts.

This is a classified report. We determined that the Office of Intelligence and Analysis continues to provide effective oversight of the department-wide intelligence system and maintains programs to monitor ongoing security practices. In addition, the United States Coast Guard is in the process of migrating its intelligence users to a system that is jointly managed by the Defense Intelligence Agency and the National Geospatial Agency. However, we determined that DHS’ information security program for intelligence systems is not effective, based on the maturity model included in this year’s reporting instructions. Specifically, DHS’ continuous monitoring tools for its intelligence system are not interoperable. DHS has not documented procedures, established formal training, and instituted qualitative and quantitative measures for continuous monitoring of its intelligence systems. We made no recommendations.

The Small Business Jobs Act of 2010 (the Act) requires the Department of Health and Human Services (the Department) to use predictive modeling and other analytics technologies (fraud-detection models) to identify improper Medicare Fee-for-Service claims that providers submit and prevent the payment of such claims. To fulfill this requirement, the Department designated the Centers for Medicare & Medicaid Services (CMS) to develop and implement the Fraud Prevention System (FPS).