Health care programs (21 - 30 of 1,056 items)
Medicaid Program Integrity: Improved Guidance Needed to Better Support Efforts to Screen Managed Care Providers
GAO-16-402: Published: Apr 22, 2016. Publicly Released: May 6, 2016.
GAO found that the selected states and Medicaid managed care plans face significant challenges in screening providers for eligibility to participate in the Medicaid program. Based on information we received from two selected states and 16 selected plans, GAO found that the states and plans used information that was fragmented across 22 databases managed by 15 different federal agencies to screen p...
Indian Health Service: Actions Needed to Improve Oversight of Patient Wait Times
GAO-16-333: Published: Mar 29, 2016. Publicly Released: Apr 28, 2016.
The Indian Health Service (IHS) has not conducted any systematic, agency-wide oversight of the timeliness of primary care provided in its federally operated facilities. IHS has delegated primary responsibility for the oversight of care provided in its facilities to its area offices and has not set any agency-wide standards for patient wait times—including both how long it should take to schedule...
VA Health Care: Actions Needed to Improve Newly Enrolled Veterans' Access to Primary Care
GAO-16-328: Published: Mar 18, 2016. Publicly Released: Apr 18, 2016.
GAO found that not all newly enrolled veterans were able to access primary care from the Department of Veterans Affairs' (VA) Veterans Health Administration (VHA), and others experienced wide variation in the amount of time they waited for care. Sixty of the 180 newly enrolled veterans in GAO's review had not been seen by providers at the time of the review; nearly half were unable to access prima...
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...
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,...
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...
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...
Rare Diseases: Too Early to Gauge Effectiveness of FDA's Pediatric Voucher Program
GAO-16-319: Published: Mar 2, 2016. Publicly Released: Mar 2, 2016.
It is too early to gauge whether the Food and Drug Administration's (FDA) pediatric voucher program has stimulated the development of drugs to treat or prevent rare pediatric diseases. Given that the typical drug development process often exceeds a decade, insufficient time has elapsed to determine whether the 3 year-old program has been effective. Any drug sponsors motivated by the program to att...
Immigration Detention: Additional Actions Needed to Strengthen Management and Oversight of Detainee Medical Care
GAO-16-231: Published: Feb 29, 2016. Publicly Released: Feb 29, 2016.
The Department of Homeland Security's (DHS) U.S. Immigration and Customs Enforcement (ICE) oversees basic on-site medical care at all facilities, as required by ICE detention standards, but does not maintain complete information about medical care costs. The ICE Health Service Corps (IHSC) provided direct care to detainees at 19 over-72-hour facilities and oversaw care at the remaining 146 non-IHS...
Health Care Fraud: Information on Most Common Schemes and the Likely Effect of Smart Cards
GAO-16-216: Published: Jan 22, 2016. Publicly Released: Feb 22, 2016.
GAO's review of 739 health care fraud cases that were resolved in 2010 showed the following:About 68 percent of the cases included more than one scheme with 61 percent including two to four schemes and 7 percent including five or more schemes.The most common health care fraud schemes were related to fraudulent billing, such as billing for services that were not provided (about 43 percent of cases)...