Beneficiaries (51 - 60 of 439 items)
Prescription Drugs: Comparison of DOD, Medicaid, and Medicare Part D Retail Reimbursement Prices
GAO-14-578: Published: Jun 30, 2014. Publicly Released: Jun 30, 2014.
GAO found that Medicaid paid the lowest average net prices across a sample of 78 high-utilization and high-expenditure brand-name and generic drugs when compared to prices paid by the Department of Defense (DOD) and Medicare Part D. Specifically, Medicaid's average net price for the entire sample was $0.62 per unit, while Medicare Part D paid an estimated 32 percent more ($0.82 per unit) and DOD p...
VA Spina Bifida Program: Outreach to Key Stakeholders and Written Guidance for Claims Audit Follow-up Activities Needed
GAO-14-564: Published: Jun 23, 2014. Publicly Released: Jun 23, 2014.
The Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) provides information and updates on covered health care services to beneficiaries enrolled in its spina bifida program, but has conducted limited outreach with key stakeholder organizations. VHA provides information on health care benefits to enrolled beneficiaries through the program website, for example. However, VHA h...
Defense Health Care: More-Specific Guidance Needed for TRICARE's Managed Care Support Contractor Transitions
GAO-14-505: Published: Jun 18, 2014. Publicly Released: Jun 18, 2014.
The recent transition of TRICARE's managed care support contractors (contractors) in the West region did not go smoothly and highlighted numerous deficiencies in guidance and oversight by the TRICARE Management Activity (TMA)—the Department of Defense's (DOD) office responsible for awarding and managing these contracts at the time of GAO's review. For example, TMA did not ensure that its outgoin...
Defense Health Care: TRICARE Dental Services Contracts' Requirements and Structure
GAO-14-497: Published: Jun 13, 2014. Publicly Released: Jun 13, 2014.
To develop requirements for its current dental services contracts, officials from the Department of Defense's (DOD) Defense Health Agency (DHA) analyzed market research, data from contractors' past performance, legislation, independent cost estimates, and other information. DHA officials used this information to align the contracts' requirements with contract goals to deliver high quality dental s...
Medicare Physical Therapy: Self-Referring Providers Generally Referred More Beneficiaries but Fewer Services per Beneficiary
GAO-14-270: Published: Apr 30, 2014. Publicly Released: Jun 2, 2014.
From 2004 to 2010, non-self-referred physical therapy (PT) services increased at a faster rate than self-referred PT services. During this period, the number of self-referred PT services per 1,000 Medicare fee-for-service beneficiaries was generally flat, while non-self-referred PT services grew by about 41 percent. Similarly, the growth rate in expenditures associated with non-self-referred PT se...
Medicare Fraud: Progress Made, but More Action Needed to Address Medicare Fraud, Waste, and Abuse
GAO-14-560T: Published: Apr 30, 2014. Publicly Released: Apr 30, 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 in prior work as helpful in protecting Medicare from fraud; however, important actions that could help CMS and its program integrity contractors combat fraud remain incomplete.Provid...
Defense Health Care: More-Specific Guidance Needed for Assessing Nonenrolled TRICARE Beneficiaries' Access to Care
GAO-14-384: Published: Apr 28, 2014. Publicly Released: Apr 28, 2014.
The Department of Defense (DOD) has devoted significant resources over the past decade—largely through national surveys of beneficiaries and civilian providers—in determining whether nonenrolled beneficiaries (those not enrolled in TRICARE Prime) have adequate access to health care. However, the lack of access standards for this population has significantly limited the department's ability to...
Medicare Imaging Accreditation: Effect on Access to Advanced Diagnostic Imaging Is Unclear amid Other Policy Changes
GAO-14-378: Published: Apr 18, 2014. Publicly Released: Apr 18, 2014.
GAO found that the number of advanced diagnostic imaging (ADI) services provided to Medicare beneficiaries in the office setting—an indicator of access to those services—began declining before and continued declining after the accreditation requirement went into effect on January 1, 2012. In particular, the rate of decline from 2009 to 2010 was similar to the rate from 2011 to 2012 for magneti...
Medicare: Second Year Update for CMS's Durable Medical Equipment Competitive Bidding Program Round 1 Rebid
GAO-14-156: Published: Mar 7, 2014. Publicly Released: Apr 8, 2014.
The Medicare competitive bidding program (CBP) for durable medical equipment (DME) is administered by the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services. Under the CBP, only competitively selected contract suppliers can furnish certain DME product categories (such as oxygen supplies and hospital beds) at competitively determined prices to Medicare...
Medicare: Contractors and Private Plans Play a Major Role in Administering Benefits
GAO-14-417T: Published: Mar 4, 2014. Publicly Released: Mar 4, 2014.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) reformed the way the Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare, contracts with claims administration contractors. From its inception, the process for selecting Medicare fee-for-service (FFS) claims administration contractors was stipulated by Congress and differed from most o...