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CMS Ensured That Medicare Shared Savings Program Beneficiaries Were Properly Assigned: Beneficiaries Were Assigned to Only One Accountable Care Organization and Were Not Assigned to Other Shared Savings Programs

The Patient Protection and Affordable Care Act established the Medicare Shared Savings Program (MSSP) to facilitate coordination and cooperation among providers and suppliers to (1) improve quality of care for Medicare fee-for-service beneficiaries and (2) reduce health care costs. Eligible providers and suppliers may voluntarily participate in the MSSP by creating or joining an accountable care organization (ACO). Beneficiary assignment is the basis for many key MSSP operations, such as determining an ACO's financial performance and reporting quality measures after each performance year (PY). The designated ACO is responsible for the quality and cost of care of its assigned Medicare beneficiaries during a PY. ACOs may be eligible to receive additional payments (i.e., shared savings payments) if they reduce health care costs and meet certain quality performance standards. ACOs may also be responsible for a portion of any shared losses.

The Centers for Medicare & Medicaid Services complied with Federal requirements when assigning beneficiaries to ACOs in the MSSP during PYs 2013 through 2015 by ensuring that MSSP beneficiaries were assigned to only one ACO and were not assigned to other savings programs. Consequently, this report contains no recommendations.

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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201