Beneficiaries (81 - 90 of 439 items) in Custom Date Range
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...
Medicaid: States Made Multiple Program Changes, and Beneficiaries Generally Reported Access Comparable to Private Insurance
GAO-13-55: Published: Nov 15, 2012. Publicly Released: Nov 15, 2012.
From 2008 to 2011, more than half of states reported maintaining or decreasing their average Medicaid application processing times--the average number of calendar days between the receipt of a new application and the final determination of eligibility. The average processing times reported by 39 states ranged from 11 to 45 calendar days. For the same time period, however, GAO was unable to assess...
Medicare Part D Coverage Gap: Discount Program Effects and Brand-Name Drug Price Trends
GAO-12-914: Published: Sep 28, 2012. Publicly Released: Oct 26, 2012.
As part of Medicare's Part D Coverage Gap Discount Program (Discount Program), the Centers for Medicare & Medicaid Services (CMS), located within the Department of Health and Human Services (HHS), oversees the provision of discounts by plan sponsors to eligible beneficiaries when they purchase brand-name drugs and monitors that discounts are paid for by drug manufacturers. CMS checks prescription...
Ambulance Providers: Costs and Medicare Margins Varied Widely; Transports of Beneficiaries Have Increased
GAO-13-6: Published: Oct 1, 2012. Publicly Released: Oct 1, 2012.
Ground ambulance providers' costs per transport for 2010 varied widely. The median cost per transport for the providers in GAO's sample was $429, ranging from $224 to $2,204 per transport. Provider characteristics that affected cost per transport were volume of transports (including both Medicare and non-Medicare transports), intensity of transports (the proportion of Medicare transports that were...
Medicare Private Health Plans: Selected Current Issues
GAO-12-1045T: Published: Sep 21, 2012. Publicly Released: Sep 21, 2012.
In March 2012, GAO issued a report on the Centers for Medicare & Medicaid Services (CMS) Medicare Advantage (MA) quality bonus payment demonstrationa demonstration CMS initiated rather than implementing the quality bonus program established under the Patient Protection and Affordable Care Act (PPACA). Compared to the PPACA quality bonus program, CMSs demonstration increases the n...
Medicare Special Needs Plans: CMS Should Improve Information Available about Dual-Eligible Plans' Performance
GAO-12-864: Published: Sep 13, 2012. Publicly Released: Sep 19, 2012.
Why GAO Did This StudyAbout 9 million of Medicare's over 48 million beneficiaries are also eligible for Medicaid because they meet income and other criteria. These dual-eligible beneficiaries have greater health care challenges than other Medicare beneficiaries, increasing their need for care coordination across the two programs. In addition to meeting all the requirements of other MA plans, D-SNP...
Medicaid: States' Use of Managed Care
GAO-12-872R: Published: Aug 17, 2012. Publicly Released: Sep 17, 2012.
In summary, we identified four groups of states that differed in their use of Medicaid managed care on the basis of the 12 indicators we included in our analysis. A handful of these indicatorsnamely Medicaid enrollment in MCOs and PCCM programs, HMO penetration rates, and the concentration of low-income individuals that lived in urban areashad significant influence on how states groupe...
Medicaid: States Reported Billions More in Supplemental Payments in Recent Years
GAO-12-694: Published: Jul 20, 2012. Publicly Released: Aug 20, 2012.
States reported $32 billion in Medicaid supplemental payments during fiscal year 2010, but the exact amount of supplemental payments is unknown because state reporting was incomplete. On expenditure reports used to obtain federal funds filed with the Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS), states reported the following:A total of $17.6 bi...
Medicare: Action Needed to Remove Social Security Numbers from Medicare Cards
GAO-12-949T: Published: Aug 1, 2012. Publicly Released: Aug 1, 2012.
In its November 2011 report, CMS presented three options for removing SSNs from Medicare cards. One option would truncate the SSN so that only the last four digits would appear on the card. However, the full SSN would continue to be used by both beneficiaries and providers for all Medicare business transactions. The other two options would replace the display of the SSN on the Medicare card with a...
Medicare Advantage: Quality Bonus Payment Demonstration Has Design Flaws and Raises Legal Concerns
GAO-12-964T: Published: Jul 25, 2012. Publicly Released: Jul 24, 2012.
Our March 2012 review found that the CMS Office of the Actuarys (OACT) estimated cost of the demonstration exceeds $8 billion over 10 years. About $5.34 billion of this estimate is attributed to quality bonus payments more generous than those prescribed in PPACA, specifically to (1) higher bonuses for 4-star and 5-star plans, (2) new bonuses for 3-star and 3.5-star plans, (3) applying bonuse...