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Offices, Department of Health and Human Services, Executive (21 - 30 of 143 items)
National Medicaid Audit Program: CMS Should Improve Reporting and Focus on Audit Collaboration with States
GAO-12-814T: Published: Jun 14, 2012. Publicly Released: Jun 14, 2012.
We found that, compared to the initial test audits and the more recent collaborative audits, the majority of the MIG audits conducted under NMAP were less effective because they used Medicaid Statistical Information System (MSIS) data. MSIS is an extract of states claims data and is missing key elements, such as provider names, that are necessary for identifying audit targets. Since fiscal y...
Group Purchasing Organizations: Federal Oversight and Self-Regulation
GAO-12-399R: Published: Mar 30, 2012. Publicly Released: Apr 30, 2012.
GPOs are subject to certain federal laws that HHS, DOJ, and FTC are responsible for enforcing. According to HHS Office of Inspector General (HHS-OIG) officials, since 2004, the office has not routinely exercised its authority to request and review disclosures related to GPOs contract administrative fees, but it has collected information on GPOs contract administrative fees while conduc...
Medicare: Implementation of Financial Incentive Programs under Federal Fraud and Abuse Laws
GAO-12-355: Published: Mar 30, 2012. Publicly Released: Apr 30, 2012.
Certain financial incentive programs are permitted within the framework of federal fraud and abuse laws, but stakeholders GAO spoke with reported that the laws, regulations, and agency guidance have created challenges for program design and implementation. The Stark law and anti-kickback statute, which restrict financial relationships among providers, have statutory and regulatory exceptions and s...
Medicare: Important Steps Have Been Taken, but More Could Be Done to Deter Fraud
GAO-12-671T: Published: Apr 24, 2012. Publicly Released: Apr 24, 2012.
The Centers for Medicare & Medicaid Services (CMS)the agency that administers Medicarehas made progress in implementing several key strategies GAO identified in prior work as helpful in protecting Medicare from fraud; however, some actions that could help combat fraud remain incomplete.Provider Enrollment: GAOs previous work found persistent weaknesses in Medicares enrollme...
Comparative Effectiveness: Agency for Healthcare Research and Quality's Process for Awarding Recovery Act Funds and Disseminating Results
GAO-12-332: Published: Feb 29, 2012. Publicly Released: Mar 30, 2012.
AHRQ used its standard, competitive review processes and criteria to select the recipients of CER grants and contracts using Recovery Act funds. Specifically, to select the recipients of Recovery Act CER grants, AHRQ used its standard review process that includes peer review of grant applications, the development of funding recommendations by a team of senior officials within AHRQ, and final fundi...
Improper Payments: Remaining Challenges and Strategies for Governmentwide Reduction Efforts
GAO-12-573T: Published: Mar 28, 2012. Publicly Released: Mar 28, 2012.
Federal agencies reported an estimated $115.3 billion in improper payments in fiscal year 2011, a decrease of $5.3 billion from the prior year reported estimate of $120.6 billion. According to the Office of Management and Budget (OMB), the $115.3 billion estimate was attributable to 79 programs spread among 17 agencies. Ten programs accounted for about $107 billion or 93 percent of the total estim...
National Preparedness: Countermeasures for Thermal Burns
GAO-12-304R: Published: Feb 22, 2012. Publicly Released: Feb 22, 2012.
The SNS contains supportive care items for thermal burns, such as bandages, pain medications, intravenous fluids, and topical antimicrobial cream needed for the immediate treatment of burn injuries to reduce the risk of infection and stabilize injured individuals. HHS officials told us that the goal of the SNS is to supplement state and local supplies used for immediate care in the initial respons...
Early Child Care and Education: HHS and Education Are Taking Steps to Improve Workforce Data and Enhance Worker Quality
GAO-12-248: Published: Feb 15, 2012. Publicly Released: Feb 15, 2012.
The paid early child care and education (ECCE) workforce was made up of approximately 1.8 million workers in a range of positions, most of whom had relatively low levels of education and income, according to Censuss 2009 American Community Survey (ACS) data. For example, nearly half of all child care workers had a high school degree or less as did 20 percent of preschool teachers. Average ye...
Health Care Quality Measurement: HHS Should Address Contractor Performance and Plan for Needed Measures
GAO-12-136: Published: Jan 13, 2012. Publicly Released: Jan 13, 2012.
NQF has made progress on projects under its contract activities, as of August 2011. Specifically, NQF has completed or made progress on 60 of 63 projects. For example, NQF has completed projects to endorse measures related to various topics, including nursing homes. However, for more than half of the projects, NQF did not meet or did not expect to meet the initial time frames approved by HHS. For...
Pre-Existing Condition Insurance Plan: Comparison of Implementation and Early Enrollment with the Children's Health Insurance Program
GAO-12-62R: Published: Nov 10, 2011. Publicly Released: Dec 13, 2011.
The federal Pre-Existing Condition Insurance Plan (PCIP) was created in 2010 to provide access to insurance for individuals previously unable to acquire coverage due to pre-existing conditions. Eligibility is limited to those who have been uninsured for at least 6 months prior to application, thus focusing the program on those who have been locked out of the private insurance market. The Patient P...