Beneficiaries (1 - 10 of 186 items)
Medicaid: Program Oversight Hampered by Data Challenges, Underscoring Need for Continued Improvements
GAO-17-173: Published: Jan 6, 2017. Publicly Released: Feb 6, 2017.
GAO found that available Medicaid expenditure and utilization data do not provide CMS with sufficient information to consistently ensure that payments are proper or that beneficiaries have access to covered services. The Centers for Medicare & Medicaid Services (CMS), the agency within the Department of Health and Human Services (HHS) that administers the Medicaid program, relies on two key data s...
Medicaid: CMS Has Taken Steps, but Further Efforts Are Needed to Control Improper Payments
GAO-17-386T: Published: Jan 31, 2017. Publicly Released: Jan 31, 2017.
GAO's prior work has identified four Medicaid program integrity issues—where the program is vulnerable to improper payments such as those made for services that were not covered, were not medically necessary, or were not provided—as well as actions taken by the Centers for Medicare & Medicaid Services (CMS) to address the issues and additional actions that should be taken.Enrollment Verificati...
Medicaid Personal Care Services: CMS Could Do More to Harmonize Requirements across Programs
GAO-17-28: Published: Nov 23, 2016. Publicly Released: Dec 22, 2016.
Four states that GAO reviewed varied in how they implemented safeguards to protect beneficiaries receiving in-home personal care services from harm and in their methods to help ensure billed services were actually provided. For example, to help keep beneficiaries safe, the four selected states—California, Maryland, Oregon, and Texas—reported that they monitored beneficiaries by having case man...
Medicaid Fee-For-Service: State Resources Vary for Helping Beneficiaries Find Providers
GAO-16-809: Published: Aug 29, 2016. Publicly Released: Sep 29, 2016.
According to the Centers for Medicare & Medicaid Services (CMS), as of July 2014, over 40 percent of nearly 71 million Medicaid beneficiaries were in fee-for-service (FFS) arrangements—traditional FFS and primary care case management—in which participating providers are paid for each delivered service (e.g., an office visit, test, or procedure). The percentage of beneficiaries in FFS arrangeme...
Medicare: 2016 Payment Rates for Complex Wheelchair Accessories
GAO-16-840R: Published: Aug 31, 2016. Publicly Released: Aug 31, 2016.
GAO reviewed 2016 Medicare payment rates for complex wheelchair accessories—both the fully adjusted rates based on the durable medical equipment competitive bidding program (CBP) and the unadjusted rates for the same items. The Centers for Medicare & Medicaid Services (CMS)—the agency that oversees the Medicare program—classifies power wheelchairs into five groups ranging from wheelchairs wi...
Medicare: Utilization and Expenditures for Complex Wheelchair Accessories
GAO-16-640R: Published: Jun 1, 2016. Publicly Released: Jun 1, 2016.
The Medicare fee-for-service (FFS) program spends millions of dollars annually to furnish wheelchairs and wheelchair accessories to Medicare beneficiaries. Certain power wheelchairs that are more complex than standard wheelchairs, referred to as complex rehabilitative technology (CRT) power group 3 wheelchairs, and the accessories used with these chairs accounted for a relatively small percentage...
Medicare Advantage: Fundamental Improvements Needed in CMS's Effort to Recover Substantial Amounts of Improper Payments
GAO-16-76: Published: Apr 8, 2016. Publicly Released: May 9, 2016.
Medicare Advantage (MA) organizations contract with the Centers for Medicare & Medicaid Services (CMS) to offer beneficiaries a private plan alternative to the original program and are paid a predetermined monthly amount by Medicare for each enrolled beneficiary. These payments are risk adjusted to reflect each enrolled beneficiary's health status and projected spending for Medicare-covered servic...
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...
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)...