Beneficiaries (21 - 30 of 186 items)
Medicare: Bidding Results from CMS's Durable Medical Equipment Competitive Bidding Program
GAO-15-63: Published: Nov 7, 2014. Publicly Released: Dec 8, 2014.
The Medicare competitive bidding program (CBP) for durable medical equipment (DME) is administered by the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS). Under the CBP, only competitively selected contract suppliers can furnish certain DME items (such as oxygen supplies and hospital beds) at competitively determined prices to Medicare benefi...
Compounded Drugs: Payment Practices Vary across Public Programs and Private Insurers, and Medicare Part B Policy Should Be Clarified
GAO-15-85: Published: Oct 10, 2014. Publicly Released: Nov 10, 2014.
Medicare, Medicaid, and private health insurers have varying payment practices for compounded drugs, depending upon whether compounded drugs and their ingredients can be identified on health insurance claims, and Medicare's Part B payment policy for these drugs is unclear.For drugs dispensed in pharmacy settings, claims contain sufficient information for public programs and private insurers to ide...
Compounded Drugs: TRICARE's Payment Practices Should Be More Consistent with Regulations
GAO-15-64: Published: Oct 2, 2014. Publicly Released: Oct 2, 2014.
The Department of Defense's (DOD) TRICARE program paid for about 465,000 compounded drug prescriptions through its pharmacy benefit in fiscal year 2013; these prescriptions represented 0.3 percent of all prescription drugs paid for through TRICARE's pharmacy benefit in that year. Most of these compounded drug prescriptions were dispensed in retail pharmacies and to retirees and their family member...
Disabled Dual-Eligible Beneficiaries: Integration of Medicare and Medicaid Benefits May Not Lead to Expected Medicare Savings
GAO-14-523: Published: Aug 29, 2014. Publicly Released: Sep 29, 2014.
Overall spending for high-expenditure disabled dual-eligible beneficiaries—those in the top 20 percent of spending in their respective states—was driven largely by Medicaid spending, and the service use and health status often differed widely between those with high Medicare expenditures and high Medicaid expenditures. For these beneficiaries, Medicaid expenditures accounted for nearly two-thi...
Medicaid Demonstrations: HHS's Approval Process for Arkansas's Medicaid Expansion Waiver Raises Cost Concerns
GAO-14-689R: Published: Aug 8, 2014. Publicly Released: Sep 8, 2014.
In approving Arkansas’s Medicaid Section 1115 demonstration, the Department of Health and Human Services (HHS) gave the state the authority to test whether providing premium assistance to purchase private coverage offered on the health insurance exchange will improve access to care for individuals newly eligible for Medicaid as a result of the Patient Protection and Affordable Care Act (PPACA).I...
Medicare Advantage: CMS Should Fully Develop Plans for Encounter Data and Assess Data Quality before Use
GAO-14-571: Published: Jul 31, 2014. Publicly Released: Sep 2, 2014.
The Centers for Medicare & Medicaid Services (CMS) is collecting Medicare Advantage (MA) encounter data—information on the services and items furnished to enrollees—that are more comprehensive than the beneficiary diagnosis data the agency currently uses to risk adjust capitated payments to MA organizations (MAO). CMS, an agency within the Department of Health and Human Services (HHS), makes t...
Medicare Fraud: Progress Made, but More Action Needed to Address Medicare Fraud, Waste, and Abuse
GAO-14-560T: Published: Apr 30, 2014. Publicly Released: Apr 30, 2014.
The Centers for Medicare & Medicaid Services (CMS)—the agency within the Department of Health and Human Services (HHS) that oversees Medicare—has made progress in implementing several key strategies GAO identified in prior work as helpful in protecting Medicare from fraud; however, important actions that could help CMS and its program integrity contractors combat fraud remain incomplete.Provid...
Medicaid: Demographics and Service Usage of Certain High-Expenditure Beneficiaries
GAO-14-176: Published: Feb 19, 2014. Publicly Released: Feb 19, 2014.
In fiscal year 2009, states spent nearly a third (31.6 percent) of all Medicaid expenditures on the most expensive Medicaid-only beneficiaries, who were 4.3 percent of total Medicaid beneficiaries. States spent another third (33.1 percent) on all other Medicaid-only beneficiaries, who represented 81.2 percent of total Medicaid beneficiaries. Among dual eligible beneficiaries, a similar pattern exi...
Medicare Program Integrity: Contractors Reported Generating Savings, but CMS Could Improve Its Oversight
GAO-14-111: Published: Oct 25, 2013. Publicly Released: Nov 25, 2013.
The Centers for Medicare and Medicaid Services (CMS) paid its Zone Program Integrity Contractors (ZPIC) about $108 million in 2012. ZPICs reported spending most of this funding on fraud case development, primarily for investigative staff, who in 2012 reported conducting about 3,600 beneficiary interviews, almost 780 onsite inspections, and reviews of more than 200,000 Medicare claims.ZPICs reporte...
Medicare Information Technology: Centers for Medicare and Medicaid Services Needs to Pursue a Solution for Removing Social Security Numbers from Cards
GAO-13-761: Published: Sep 10, 2013. Publicly Released: Oct 17, 2013.
The Centers for Medicare and Medicaid Services (CMS)--which is the agency within the Department of Health and Human Services (HHS) responsible for administering Medicare--has not taken needed steps, such as designating a business owner and establishing a business case for an information technology (IT) project, that would result in selecting and implementing a technical solution for removing Socia...