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Offices, Department of Health and Human Services, Executive (21 - 30 of 199 items)
Medicare Fraud: Further Actions Needed to Address Fraud, Waste, and Abuse
GAO-14-712T: Published: Jun 25, 2014. Publicly Released: Jun 25, 2014.
The Centers for Medicare & Medicaid Services (CMS)—the agency within the Department of Health and Human Services (HHS) that oversees Medicare—has made progress in implementing several key strategies GAO identified or recommended in prior work as helpful in protecting Medicare from fraud; however, implementing other important actions that GAO recommended could help CMS and its program integrity...
Medicaid Program Integrity: Increased Oversight Needed to Ensure Integrity of Growing Managed Care Expenditures
GAO-14-341: Published: May 19, 2014. Publicly Released: Jun 18, 2014.
GAO identified a gap in state and federal efforts to ensure Medicaid managed care program integrity. Federal laws require the states and the Centers for Medicare & Medicaid Services (CMS) to ensure the integrity of the Medicaid program, including payments under Medicaid managed care, which are growing at a faster rate than payments under fee-for-service (FFS). However, five state program integrity...
Electronic Health Records: HHS Strategy to Address Information Exchange Challenges Lacks Specific Prioritized Actions and Milestones
GAO-14-242: Published: Mar 24, 2014. Publicly Released: Mar 24, 2014.
Providers and stakeholders GAO interviewed in four states with ongoing electronic health information exchange efforts cited key challenges to exchange, in particular, issues related to insufficient standards, concerns about how privacy rules can vary among states, difficulties in matching patients to their records, and costs associated with exchange. Officials from the Centers for Medicare & Medic...
Electronic Health Record Programs: Participation Has Increased, but Action Needed to Achieve Goals, Including Improved Quality of Care
GAO-14-207: Published: Mar 6, 2014. Publicly Released: Mar 6, 2014.
Based on the number of providers awarded incentive payments, participation in the Department of Health and Human Services' (HHS) Medicare and Medicaid Electronic Health Record (EHR) programs increased substantially from their first year in 2011 to 2012. For hospitals, participation increased from 45 percent of those eligible for 2011 to 64 percent of those eligible for 2012. For professionals, suc...
Health Care Fraud and Abuse Control Program: Indicators Provide Information on Program Accomplishments, but Assessing Program Effectiveness is Difficult
GAO-13-746: Published: Sep 30, 2013. Publicly Released: Oct 30, 2013.
In fiscal year 2012, the Department of Health and Human Services (HHS), HHS Office of Inspector General (HHS-OIG), and the Department of Justice (DOJ) obligated approximately $583.6 million to fund Health Care Fraud and Abuse Control (HCFAC) program activities. About 78 percent of obligated funds were from mandatory HCFAC appropriations (budgetary resources provided in laws other than appropriatio...
Medicare: Higher Use of Costly Prostate Cancer Treatment by Providers Who Self-Refer Warrants Scrutiny
GAO-13-525: Published: Jul 19, 2013. Publicly Released: Aug 1, 2013.
The number of Medicare prostate cancer-related intensity-modulated radiation therapy (IMRT) services performed by self-referring groups increased rapidly, while declining for non-self-referring groups from 2006 to 2010. Over this period, the number of prostate cancer-related IMRT services performed by self-referring groups increased from about 80,000 to 366,000. Consistent with that growth, expend...
Indian Health Service: Capping Payment Rates for Nonhospital Services Could Save Millions of Dollars for Contract Health Services
GAO-13-272: Published: Apr 11, 2013. Publicly Released: Apr 11, 2013.
The Indian Health Service's (IHS) federal contract health services (CHS) programs primarily paid physicians at their billed charges, which were significantly higher than what Medicare and private insurers would have paid for the same services. IHS's policy states that federal CHS programs should purchase services from contracted providers at negotiated, reduced rates. However, of the almost $63 mi...
Health Care Fraud: Types of Providers Involved in Medicare Cases, and CMS Efforts to Reduce Fraud
GAO-13-213T: Published: Nov 28, 2012. Publicly Released: Nov 28, 2012.
In recently completed work, we found that medical facilities (such as medical centers, clinics, and practices) and durable medical equipment suppliers were the most frequent subjects of criminal fraud cases in Medicare, Medicaid, and CHIP in 2010. Hospitals and medical facilities were the most frequent subjects of civil fraud cases, including cases that resulted in judgments or settlements. Accord...
Prevention and Public Health Fund: Activities Funded in Fiscal Years 2010 and 2011
GAO-12-788: Published: Sep 13, 2012. Publicly Released: Oct 15, 2012.
For fiscal years 2010 and 2011, the Department of Health and Human Services (HHS) allocated funds from the Prevention and Public Health Fund (PPHF) for 43 activities in five agencies. These activitieswhich include HHS programs and initiativeswere administered by HHSs Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), Health Resour...
Health Care Fraud: Types of Providers Involved in Medicare, Medicaid, and the Children's Health Insurance Program Cases
GAO-12-820: Published: Sep 7, 2012. Publicly Released: Oct 9, 2012.
According to 2010 data from the Department of Health and Human Services' Office of the Inspector General (HHS-OIG) and the Department of Justice (DOJ), 10,187 subjects--individuals and entities involved in fraud cases--were investigated for health care fraud, including fraud in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). These subjects included different types of provid...