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Department of Health and Human Services, Executive (1 - 9 of 9 items)
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...
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...
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: Health Care Fraud and Abuse Control Program for Fiscal Years 2000 and 2001
GAO-02-731: Published: Jun 3, 2002. Publicly Released: Jun 3, 2002.
The Medicare program is the nation's largest health insurer with almost 40 million beneficiaries and outlays of over $219 billion annually. Because of the susceptibility of the program to fraud and abuse, Congress enacted the Health Care Fraud and Abuse Control (HCFAC) Program as part of the Health Insurance Portability and Accountability Act (HIPPAA) of 1996. HCFAC, which is administered by the D...
Medicare: Health Care Fraud and Abuse Control Program Financial Reports for Fiscal Years 1998 and 1999
AIMD-00-257R: Published: Jul 31, 2000. Publicly Released: Jul 31, 2000.
Pursuant to a legislative requirement, GAO reviewed the Health Care Fraud and Abuse Control (HCFAC) Program financial reports for fiscal years (FY) 1998 and 1999 as required by the the Health Insurance Portability and Accountability Act (HIPAA) of 1996.GAO noted that: (1) the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) joint HCFAC reports for fiscal years 1998...
Medicare Improper Payments: Challenges for Measuring Potential Fraud and Abuse Remain Despite Planned Enhancements
T-AIMD/OSI-00-251: Published: Jul 12, 2000. Publicly Released: Jul 12, 2000.
Pursuant to a congressional request, GAO discussed the Health Care Financing Administration's (HCFA) efforts to improve the measurement of improper payments in the Medicare fee-for-service program.GAO noted that: (1) because it was not intended to include procedures designed specifically to identify all types of potential fraudulent and abusive activity, the current methodology does not provide an...
Medicare: Improprieties by Contractors Compromised Medicare Program Integrity
OSI-99-7: Published: Jul 14, 1999. Publicly Released: Jul 14, 1999.
Pursuant to a congressional request, GAO determined whether Medicare contractors participated in any improper or questionable practices that contributed to fraud, waste, or abuse in the Medicare federal health insurance program, focusing on: (1) recently completed cases of criminal conduct or False Claims Act violations committed by Medicare contractors; (2) the deceptive contractor activities set...
Medicare: Early Evidence of Compliance Program Effectiveness Is Inconclusive
HEHS-99-59: Published: Apr 15, 1999. Publicly Released: Apr 15, 1999.
Pursuant to a congressional request, GAO reviewed the compliance programs established by health care providers to reduce improper payments by Medicare, focusing on the: (1) prevalence of compliance programs among hospitals and other Medicare providers; (2) costs involved with compliance programs; and (3) effectiveness of the programs, to the extent that could be measured.GAO noted that: (1) althou...
Use of False Claims Act for Medicare Outpatient Claims Cases
B-279893: Published: Jul 22, 1998. Publicly Released: Aug 26, 1998.
Pursuant to a congressional request, GAO addressed a number of issues concerning the Department of Health and Human Services' (HHS) and the Department of Justice's (DOJ) enforcement of the False Claims Act against hospitals submitting improper Medicare claims for outpatient services. GAO held that: (1) there was no evidence that errors hospitals made with respect to HHS' and DOJ's 72-hour rule wer...