Health care programs (121 - 130 of 1,056 items)
Medicaid: Enrollment and Expenditures for Qualified Individual and Transitional Medical Assistance Programs
GAO-13-177R: Published: Dec 12, 2012. Publicly Released: Jan 11, 2013.
The QI program enrolled about 426,000 individuals nationwide in 2009--the most recent year for which comprehensive enrollment data were available--with expenditures of about $431 million. While QI enrollment increased 30 percent from fiscal year 2006 to fiscal year 2009, program expenditures increased at a slightly faster rate, rising 39 percent during this time. On average, one quarter of individ...
Preventive Health Activities: Available Information on Federal Spending, Cost Savings, and International Comparisons Has Limitations
GAO-13-49: Published: Dec 6, 2012. Publicly Released: Jan 7, 2013.
The Departments of Health and Human Services (HHS), Veterans Affairs (VA), and Defense (DOD) administer programs that include preventive health activities such as health screenings and education campaigns, but the departments reported that they do not track department-wide spending on these activities. Departments reported that determining such spending is challenging because these activities can...
Medicaid and CHIP: Considerations for Express Lane Eligibility
GAO-13-178R: Published: Dec 5, 2012. Publicly Released: Dec 21, 2012.
Four key considerations related to ELE's availability beyond 2013 include (1) the potential for administrative savings; (2) effects on enrollment of eligible, but not enrolled, children; (3) states' level of interest in using ELE particularly for implementing PPACA; and (4) uncertainty regarding the potential for erroneous excess payments for children enrolled through ELE.Available information reg...
Medicare Program Integrity: Greater Prepayment Control Efforts Could Increase Savings and Better Ensure Proper Payment
GAO-13-102: Published: Nov 13, 2012. Publicly Released: Dec 10, 2012.
Use of prepayment edits saved Medicare at least $1.76 billion in fiscal year 2010, but GAO found that savings could have been greater had prepayment edits been more widely used. GAO illustrated this point using analysis of a limited number of national policies and local coverage determinations (LCD), which are established by each Medicare administrative contractor (MAC) to specify coverage rules i...
Medicaid: Data Sets Provide Inconsistent Picture of Expenditures
GAO-13-47: Published: Oct 29, 2012. Publicly Released: Nov 29, 2012.
Medicaid expenditures in the Medicaid Statistical Information System (MSIS) were generally less than CMS-64 amounts. National expenditures in MSIS were 86, 87, and 88 percent of the amounts in CMS-64 in fiscal years 2007 through 2009, respectively. In fiscal year 2009, MSIS expenditures for states ranged from 59 to 119 percent of CMS-64. Specifically, 40 states reported lower expenditures in MSIS...
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...
Returned Peace Corps Volunteers: Labor and Peace Corps Need Joint Approach to Monitor Access to and Quality of Health Care Benefits
GAO-13-27: Published: Nov 19, 2012. Publicly Released: Nov 19, 2012.
From 2009 through 2011, the Department of Labor (DOL) provided a total of about $36 million in Federal Employees' Compensation Act (FECA) benefits--health and other benefits--for Peace Corps volunteers who have returned from service abroad (volunteers). Specifically, DOL provided about $22 million in health care benefits for these volunteers in the form of reimbursements for medical expenses relat...
Recovering Servicemembers and Veterans: Sustained Leadership Attention and Systematic Oversight Needed to Resolve Persistent Problems Affecting Care and Benefits
GAO-13-5: Published: Nov 16, 2012. Publicly Released: Nov 16, 2012.
Deficiencies exposed at Walter Reed Army Medical Center in 2007 served as a catalyst compelling the Departments of Defense (DOD) and Veterans Affairs (VA) to address a host of problems for wounded, ill, and injured servicemembers and veterans as they navigate through the recovery care continuum. This continuum extends from acute medical treatment and stabilization, through rehabilitation to reinte...
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...