Health insurance cost control (71 - 80 of 83 items)
Government Contractors: Criteria Needed for Allowable Employee Health Care Costs
T-HRD-88-12: Published: Mar 16, 1988. Publicly Released: Mar 16, 1988.
GAO discussed efforts to ensure that the employee health care costs that the federal government pays under negotiated contracts are reasonable. GAO found that: (1) in 1985, the government reimbursed its 10 largest contractors about $1.2 billion for their health care expenses, or about $2,344 per employee; (2) these costs exceeded the average per-employee costs that contractors, manufacturers, and...
Medicare: Hospital Payment Rates Should Be Revised To Assure Reasonableness and Equity
T-HRD-88-9: Published: Mar 1, 1988. Publicly Released: Mar 1, 1988.
Pursuant to a congressional request, GAO discussed Medicare's Prospective Payment System (PPS) hospital rates. GAO noted that: (1) the original PPS rates were too high because they incorporated unaudited cost data, including unallowable costs and costs for unnecessary services; (2) subsequent annual updates and adjustments to rates have used estimated and incomplete data; (3) costs of services cov...
Medicare: Comparison of Catastrophic Health Insurance Proposals--An Update
HRD-88-19BR: Published: Oct 16, 1987. Publicly Released: Oct 23, 1987.
GAO updated its report on proposed legislation to relieve elderly Medicare beneficiaries from out-of-pocket catastrophic health care expenses.GAO found that two newly proposed bills would: (1) place an upper limit on beneficiary liability for certain Medicare deductibles and coinsurance; (2) cap physician services, hospital care, and skilled nursing facility coinsurance during the first 150 days,...
Medicare: Prescription Drug Issues
PEMD-87-20: Published: Jul 16, 1987. Publicly Released: Aug 14, 1987.
In response to a congressional request, GAO provided information about prescription drugs as they relate to the needs of the elderly.GAO found that: (1) more than 75 percent of persons older than 65 in the United States use prescription drugs; (2) 90 percent of the elderly who are chronically ill use prescription drugs; (3) persons 65 and older use 30 percent of all the prescription drugs used in...
Medicare: Comparison of Catastrophic Health Insurance Proposals
HRD-87-92BR: Published: Jun 19, 1987. Publicly Released: Jul 6, 1987.
In response to a congressional request, GAO reviewed 14 legislative proposals that would provide coverage of catastrophic health care costs to determine the potential effects on Medicare beneficiaries.GAO found that: (1) the bills would either place a limit on beneficiary liability for Medicare deductibles and coinsurance or attempt to provide for some of the costs not currently covered under Medi...
The Congress Should Consider Amending the Medicare Secondary Payer Provisions To Include Disability Beneficiaries
HRD-85-102: Published: Sep 30, 1985. Publicly Released: Sep 30, 1985.
Over the past several years, Congress has amended the Social Security Act to require that, when beneficiaries between the ages of 65 and 70 and those with end stage renal disease are covered under employer-sponsored group health insurance, private insurance pays for medical services before Medicare. Because of congressional actions to make Medicare the secondary payer for other beneficiaries cover...
Reimbursing Physicians Under Medicare on the Basis of Their Specialty
HRD-84-94: Published: Sep 27, 1984. Publicly Released: Sep 27, 1984.
Federal regulations permit Medicare carriers to allow differences in prevailing reimbursement rates based on differences in charging patterns among various physician specialties. The regulations require carriers to compare charging patterns among physician specialties and justify either single or multiple prevailing rates. In addition, Medicare permits carriers to recognize each physician in the s...
Public Representation on Boards and Blue Shield Allowances: Important Relationship Not Found
HRD-81-31: Published: Dec 31, 1980. Publicly Released: Jan 12, 1981.
GAO was asked to determine if there is an ascertainable difference in cost-containment efforts between Blue Shield plans with boards of directors apparently controlled by public representatives versus those with a majority of health care provider members.GAO analyses neither conclusively affirmed nor denied that public representation on Blue Shield plans' boards of directors was importantly associ...
OPM Should Promote Medical Necessity Programs for Federal Employees' Health Insurance
HRD-80-79: Published: Jul 29, 1980. Publicly Released: Aug 8, 1980.
Medical necessity programs were developed to help contain health care costs and promote good health care. They can reduce the incidence of, and payment for, health care procedures not found to be medically necessary or consistent with generally acceptable medical practice. Federal Employees' Health Benefits Program plans have varied greatly in their use of medical necessity programs, but data from...
Stronger Management Needed To Improve Employee Organization Health Plans' Payment Practices
HRD-79-87: Published: Sep 7, 1979. Publicly Released: Sep 17, 1979.
The Office of Personnel Management (OPM) has not done an effective job of guiding and overseeing the Employee Organization Plans participating in the Federal Employees Health Benefits program. OPM has allowed the plans to make claim payments without determining whether the claims represented sound comprehensive systems to determine the reasonableness of charges as the contracts require.The Plans h...