Managed health care (41 - 50 of 209 items)
Medicare Part D: CMS Oversight of Part D Sponsors' Fraud and Abuse Programs Has Been Limited, but CMS Plans Oversight Expansion
GAO-10-481T: Published: Mar 3, 2010. Publicly Released: Mar 3, 2010.
Medicare Part D, the voluntary, outpatient prescription drug benefit for eligible individuals 65 years and older and certain individuals with disabilities, is at risk for fraud, waste, and abuse. Part D is administered by the Centers for Medicare & Medicaid Services (CMS). All Part D sponsors--private companies that operate Part D benefit plans--are required to have programs to safeguard the Part...
Medicaid and CHIP: Enrollment, Benefits, Expenditures, and Other Characteristics of State Premium Assistance Programs
GAO-10-258R: Published: Jan 19, 2010. Publicly Released: Jan 19, 2010.
Fiscal pressures, rising health care costs, and increases in the number of uninsured may lead states to look toward public-private partnerships to help finance health insurance coverage. Through Medicaid and the State Children's Health Insurance Program (CHIP), states have had long-standing authority to operate premium assistance programs that subsidize the purchase of private health insurance. En...
Medicare Managed Care: Observations about Medicare Cost Plans
GAO-10-185: Published: Dec 28, 2009. Publicly Released: Dec 28, 2009.
Medicare cost plans--managed care plans paid based on the reasonable costs of delivering Medicare-covered services--enroll a small number of beneficiaries compared to Medicare Advantage (MA), Medicare's managed care program in which the plans accept financial risk if their costs exceed fixed payments received for each enrolled beneficiary. Despite the small enrollment, industry representatives sta...
Health Resources and Services Administration: Many Underserved Areas Lack a Health Center Site, and Data Are Needed on Service Provision at Sites
GAO-09-667T: Published: Apr 30, 2009. Publicly Released: Apr 30, 2009.
Health centers funded through grants under the Health Center Program--managed by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS)--provide comprehensive primary care services for the medically underserved. The statement GAO is issuing today summarizes an August 2008 report, Health Resources and Services Administration: Many Underserv...
Medicare: Improvements Needed to Address Improper Payments in Home Health
GAO-09-185: Published: Feb 27, 2009. Publicly Released: Mar 13, 2009.
Medicare spending on home health totaled $12.9 billion in 2006, up 44 percent from 2002. Concerns have been raised that improper payments from practices indicating fraud and abuse may have contributed to Medicare home health spending and utilization. The Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare, is responsible for minimizing improper payments made on beh...
Traumatic Brain Injury: Better DOD and VA Oversight Can Help Ensure More Accurate, Consistent, and Timely Decisions for the Traumatic Injury Insurance Program
GAO-09-108: Published: Jan 29, 2009. Publicly Released: Jan 29, 2009.
In 2005, Congress created a traumatic injury insurance benefit program, known as TSGLI, to help servicemembers with traumatic brain injury and other serious injuries with the financial burdens that they and their families face. The Department of Veterans Affairs (VA) administers the program, in collaboration with the Department of Defense (DOD), while the branches of service are responsible for de...
Medicare Part D: Opportunities Exist for Improving Information Sent to Enrollees and Scheduling the Annual Election Period
GAO-09-4: Published: Dec 12, 2008. Publicly Released: Dec 12, 2008.
In Medicare Part D, enrollees in stand-alone prescription drug plans (PDPs) are allowed to switch plans during an annual coordinated election period (AEP) set under law from November 15 to December 31, with new coverage effective January 1. The Centers for Medicare & Medicaid Services (CMS) required that plan sponsors send an Annual Notice of Change (ANOC)--using either its model or a nonmodel for...
Medicare Advantage Organizations: Actual Expenses and Profits Compared to Projections for 2006
GAO-09-132R: Published: Dec 8, 2008. Publicly Released: Dec 11, 2008.
The federal government's spending on the Medicare Advantage (MA) program has grown substantially in recent years, from approximately $60 billion in 2006 and $77 billion in 2007 to an estimated $91 billion in 2008. MA organizations provide health care coverage to Medicare beneficiaries through private health plans, thus offering an alternative to the original Medicare fee-for-service (FFS) program...
Medicare Part D Prescription Drug Coverage: Federal Oversight of Reported Price Concessions Data
GAO-08-1074R: Published: Sep 30, 2008. Publicly Released: Oct 30, 2008.
To help Medicare beneficiaries manage the rising cost of prescription drugs, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which established the outpatient prescription drug benefit known as Medicare Part D. The benefit was first available in January 2006, and that year it provided federally subsidized prescription drug coverage for nearly 28 mil...
Health Resources and Services Administration: Many Underserved Areas Lack a Health Center Site, and the Health Center Program Needs More Oversight
GAO-08-723: Published: Aug 8, 2008. Publicly Released: Sep 11, 2008.
Health centers funded through grants under the Health Center Program--managed by the Health Resources and Services Administration (HRSA), an agency in the U.S. Department of Health and Human Services (HHS)--provide comprehensive primary care services for the medically underserved. HRSA provides funding for training and technical assistance (TA) cooperative agreement recipients to assist grant appl...