The Department of Veterans Affairs and Centers for Medicare & Medicaid Services are failing to adequately combat improper payments totaling $24.3 billion across two federally designated high-priority programs, according to a Government Accountability Office report released in 2026.
The VA Community Care program reported an improper payment estimate of $608 million for fiscal year 2025, representing 2.4 percent of the program’s total outlays. The CMS Medicare Advantage program reported a far larger improper payment estimate of $23.7 billion for the same period, or 6.1 percent of program spending. Both programs were designated as high-priority for improper payments by the Office of Management and Budget for fiscal year 2025, placing them among 30 government programs flagged for payment integrity concerns.
The GAO found significant gaps in how both agencies address fraud and improper payments. While the VA met key requirements by developing processes to identify root causes and implementing adequate corrective action plans, the agency has not conducted a comprehensive fraud risk assessment for Community Care. According to the report, “these efforts do not meet the key elements of a fraud risk assessment and have not resulted in a comprehensive fraud risk assessment for the program, leaving it vulnerable to fraud.”
CMS’s performance was worse. Although the agency developed a process to identify root causes of improper payments in Medicare Advantage, “its estimated improper payment rate has not decreased but remained steady.” The report found that “CMS’s corrective action plans are not sufficiently detailed and do not adequately monitor progress.”
A critical weakness identified by GAO involves Risk Adjustment Data Validation (RADV) audits, CMS’s primary tool for identifying and recovering improper payments in Medicare Advantage. The agency lacks “a detailed plan for expediting Risk Adjustment Data Validation (RADV) audits,” and a growing backlog of these audits has created “significant delays in its recovery efforts.”
Neither agency has conducted comprehensive fraud risk assessments. The GAO concluded that “CMS’s efforts to reduce improper payments and fraud in the Medicare Advantage program will be inadequate without comprehensive corrective action plans and fraud risk assessments.”
The GAO examined agency documentation, prior inspector general reports, and interviewed officials from both agencies and trade associations between November 2024 and June 2026 to assess efforts to identify and address improper payment and fraud risks.
