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Fact #1:  Because of Scoring Guidelines, CBO Does Not “Score” Program Integrity Provisions as Saving Money. 

An analyst from the nonpartisan Congressional Research Service has explained that, with regard to program integrity initiatives, at least one of two scorekeeping guidelines apply, depending on whether the program integrity initiatives are funded as discretionary spending or direct spending (i.e., mandatory spending): rule #3 and rule #14.  These rules, from the “Scorekeeping Guidelines” published in the Joint Explanatory Statement of the Committee of Conference on H.R. 2015 (105th Congress), are used to measure compliance with congressional and statutory budget rules.[1] 


Entitlements and other mandatory programs (including offsetting receipts) will be scored at current law levels as defined in section 257 of GRH, unless Congressional action modifies the authorization legislation. Substantive changes to or restrictions on entitlement law or other mandatory spending law in appropriations laws will be scored against the Appropriations Committee section 302(b) allocations in the House and the Senate. For the purpose of CBA scoring, direct spending savings that are included in both an appropriation bill and a reconciliation bill will be scored to the reconciliation bill and not to the appropriation bill. For scoring under sections 251 or 252 of GRH, such provisions will be scored to the first bill enacted.



No increase in receipts or decrease in direct spending will be scored as a result of provisions of a law that provides direct spending for administration or program management activities.” 

These rules effectively mean that, unless Congress changes the basic nature of the Medicaid and Medicare programs as an entitlement – or changes the scoring rules themselves – CBO is not allowed, for scorekeeping purposes, to assign savings to most program integrity provisions.

Fact #2: Because of Fact #1, CBO Assumes That CMS Uses Its Program Integrity Funding in the Most Efficient and Most Effective Manner.

Despite a wealth of analysis from GAO reports and Inspector General reports showing gaps, failures, and limitations in CMS’s administration of program integrity initiatives, according to conversations with CBO staff, CBO said they assume CMS uses its program integrity funding in the most effective manner.  This assumption is understandable given the restrictions of the scoring conventions CBO must uphold, but it f clearly is a scoring convention that does not necessarily reflect real-world experience and an abundance of data to the contrary. Assessing this assumption critically, one downside of CBO assuming CMS is doing a top job under current law is that this assumption is biased toward the status quo and does not take into account the relevant merits of specific policies. 

Fact #3:  While Scorekeeping Guidelines Prevent CBO From Include Savings In Its Official Score For Scorekeeping Purposes, CBO Does Estimate That Program Integrity Initiatives Provisions Do Save Money.

In its August 1 estimate of the Budget Control Act of 2011, CBO explained that increasing the budget caps (and thus appropriations) to the Health Care Fraud and Abuse Control fund would result in real savings to the program, even though those savings are not scorable under the convention of the budget rules.   CBO said: “If the Congress were to appropriate the maximum amounts eligible for the cap adjustment related to HCFAC, spending for such activities would be about $3 billion above CBO’s baseline. Based on that increase, CBO estimates that benefit outlays for Medicare, Medicaid, and CHIP would fall by about $3.7 billion over the 2012-2021 period. Additional savings would accrue after 2021.” In Table 2 of the same document, CBO shows a $2.9 billion increase in HCFAC funding results in a -$3.7 billion “Non-Scorable Effects on Direct Spending Outlays” – or in other words, $3.7 billion (roughly $800 million net) in real savings for taxpayers that do not count under budget rules.

[1] The House Budget Committee compendium titles these guidelines as that of CBO and OMB, but CRS notes they  actually apply to all “scorekeepers,” including both Budget Committees.  

Document available here.