A recent Government Accountability Office (GAO) report, “Centers for Medicare and Medicaid Services: Deficiencies in Contract Management Internal Control Are Pervasive,” raises concerns that CMS contract management practices “increase the risk of improper payments or waste.” Among other things, based on the GAO’s review of a sample of 2008 CMS contract actions, the GAO concluded that least 84.3% of FY 2008 contract actions contained at least one instance where a key control was not adequately implemented (such as ensuring project officers certify invoices for payment). These deficiencies were due in part to a lack of agency-specific policies and procedures to help ensure proper contracting expenditures. The GAO also charges that CMS did not fully implement recommendations GAO made in 2007 to improve internal control over contracting and payments to contractors. The report warns that “continuing weaknesses in contracting activities and limited progress in addressing known deficiencies will continue to put billions of taxpayer dollars at risk of improper payments or waste.” The GAO makes 10 recommendations for developing policies to improve oversight and strengthen CMS’s control environment.