Department of Health and Human Services (101 - 110 of 2,598 items)
Medicare: Opportunities Exist to Recover Potential Overpayments to Providers with Criminal Backgrounds
GAO-16-365R: Published: Apr 13, 2016. Publicly Released: Apr 13, 2016.
Opportunities exist for the Centers for Medicare & Medicaid Services (CMS) to recover about $1.3 million in potential overpayments to 16 out of 66 potentially ineligible providers with criminal backgrounds who were enrolled in Medicare before CMS implemented more extensive background-check processes in April 2014. These 16 providers had Medicare claims paid to them while they were potentially inel...
Healthcare.gov: Actions Needed to Enhance Information Security and Privacy Controls
GAO-16-265: Published: Mar 23, 2016. Publicly Released: Mar 23, 2016.
The Centers for Medicare & Medicaid Services (CMS) reported 316 security-related incidents, between October 2013 and March 2015, affecting Healthcare.gov—the web portal for the federal health insurance marketplace—and its supporting systems. According to GAO's review of CMS records for this period, the majority of these incidents involved such things as electronic probing of CMS systems by pot...
Patient Protection and Affordable Care Act: CMS Should Act to Strengthen Enrollment Controls and Manage Fraud Risk
GAO-16-506T: Published: Mar 17, 2016. Publicly Released: Mar 17, 2016.
The Patient Protection and Affordable Care Act (PPACA) requires applicant information be verified to determine eligibility for enrollment or income-based subsidies. To implement this verification process, the Centers for Medicare & Medicaid Services (CMS) created an electronic system called the “data services hub” (data hub), which, among other things, provides a single link to federal sources...
Private Health Insurance: Federal Oversight Premiums and Enrollment for Consumer Operated and Oriented Plans in 2015
GAO-16-326: Published: Mar 10, 2016. Publicly Released: Mar 17, 2016.
The Centers for Medicare & Medicaid Services' (CMS) monitoring of the consumer governed, nonprofit health insurance issuers—known as consumer operated and oriented plans (CO-OPs)—evolved as the CO-OP program matured, and as 12 of the 23 CO-OPs ceased operations on or before January 1, 2016. CMS's initial monitoring activities, starting when it began to award CO-OP program loans in early 2012,...
National Institutes of Health: Additional Data Would Enhance the Stewardship of Clinical Trials across the Agency
GAO-16-304: Published: Mar 10, 2016. Publicly Released: Mar 10, 2016.
Although the National Institutes of Health (NIH) assessed the applicability of recommendations made by the Institute of Medicine (IOM) in 2010 to improve clinical trials—studies involving human subjects that test the effects of interventions on health-related outcomes—within one of its Institutes and Centers (IC), NIH did not apply the recommendations across its ICs. In response to a conferenc...
Temporary Assistance for Needy Families: Update on States Counting Third-Party Expenditures toward Maintenance of Effort Requirements
GAO-16-315: Published: Feb 10, 2016. Publicly Released: Mar 10, 2016.
Nearly one-third of states (16 of 51) reported counting nongovernmental third-party expenditures toward their states' required spending level under the Temporary Assistance for Needy Family (TANF) block grant in fiscal year 2015, according to GAO's survey of all state TANF directors. TANF requires states to maintain a significant portion of their own historic financial commitment, called maintenan...
Medicaid: Federal Guidance Needed to Address Concerns About Distribution of Supplemental Payments
GAO-16-108: Published: Feb 5, 2016. Publicly Released: Mar 7, 2016.
Not all selected hospitals in the four states GAO reviewed tracked their use of revenues from the large supplemental payments they received and tracking of revenues is generally not required. Based on information obtained from hospital officials and a review of demonstration approval documents, GAO determined that the revenues were used for a broad range of purposes. For example,Officials from nin...
Provider Networks: Comparison of Child-Focused Network Adequacy Standards between CHIP and Private Health Plans
GAO-16-219: Published: Feb 5, 2016. Publicly Released: Mar 7, 2016.
Broad federal provider network adequacy standards apply to health plans in the joint federal-state State Children's Health Insurance Program (CHIP) and to qualified health plans (QHP)—private health plans offered on health insurance exchanges. These standards measure the adequacy of the networks of physicians, hospitals, and other providers participating in each plan. The five selected states GA...
Nonemergency Medical Transportation: Updated Medicaid Guidance Could Help States
GAO-16-238: Published: Feb 2, 2016. Publicly Released: Mar 3, 2016.
The nonemergency medical transportation (NEMT) benefits offered by Medicare and Medicaid differ. Medicare provides NEMT via ambulance only when other means of transportation, such as a taxi or wheelchair van, would jeopardize the health of the beneficiary. Medicaid NEMT is generally available for beneficiaries who have no other means of transportation to medical services. States are responsible fo...
Emerging Infectious Diseases: Preliminary Observations on the Zika Virus Outbreak
GAO-16-470T: Published: Mar 2, 2016. Publicly Released: Mar 2, 2016.
While several countries have reported outbreaks of Zika virus disease—which appear to be primarily transmitted to humans by mosquitos—unanswered questions remain regarding the epidemiology and transmission of the disease. Many factors—including a large number of asymptomatic patients and patients with mild symptoms, and a lack of a consistent international case definition of Zika virus disea...