Medical expense claims (11 - 20 of 64 items)
Medicare: CMS's Program Safeguards Did Not Deter Growth in Spending for Power Wheelchairs
GAO-05-43: Published: Nov 17, 2004. Publicly Released: Dec 15, 2004.
Medicare spending for power wheelchairs--one of the program's most expensive items of durable medical equipment (DME)--rose more than fourfold from 1999 through 2003, while overall Medicare spending rose by about 11 percent for the same period, according to the Centers for Medicare & Medicaid Services (CMS). This spending growth has raised concerns that some of the payments may have been improper...
Medicare: Incomplete Plan to Transfer Appeals Workload from SSA to HHS Threatens Service to Appellants
GAO-05-45: Published: Oct 4, 2004. Publicly Released: Oct 4, 2004.
The Medicare appeals process has been the subject of widespread concern in recent years because of the time it takes to resolve appeals of denied claims. Two federal agencies play a role in deciding appeals--the Department of Health and Human Services (HHS) and the Social Security Administration (SSA). Currently, neither agency manages and oversees the entire multilevel process. In the Medicare Pr...
Medicare: CMS Did Not Control Rising Power Wheelchair Spending
GAO-04-716T: Published: Apr 28, 2004. Publicly Released: Apr 28, 2004.
Medicare spending for power wheelchairs, one of the program's most expensive items of durable medical equipment (DME), rose 450 percent from 1999 through 2003, while overall Medicare spending rose by about 11 percent for the same period, according to the Centers for Medicare & Medicaid Services (CMS). This spending growth has raised concerns that Medicare made improper payments and has payment rat...
Private Health Insurance: Employers and Individuals Are Vulnerable to Unauthorized or Bogus Entities Selling Coverage
GAO-04-312: Published: Feb 27, 2004. Publicly Released: Mar 3, 2004.
Health insurance premiums have increased at double-digit rates over the past few years. While searching for affordable options, some employers and individuals have purchased coverage from certain entities that are not authorized by state insurance departments to sell this coverage. Such unauthorized entities--also sometimes referred to as bogus entities or scams--may collect premiums and not pay s...
Private Health Insurance: Unauthorized or Bogus Entities Have Exploited Employers and Individuals Seeking Affordable Coverage
GAO-04-512T: Published: Mar 3, 2004. Publicly Released: Mar 3, 2004.
As health insurance premiums have risen at double-digit rates in recent years, employers and individuals who have sought to purchase more affordable coverage have fallen prey to certain entities that may offer attractively priced premiums but do not fulfill the expectations of those buying health insurance. These unauthorized entities--also known as bogus entities or scams--may not meet the financ...
Medicare: Recent CMS Reforms Address Carrier Scrutiny of Physicians' Claims for Payment
GAO-02-693: Published: May 28, 2002. Publicly Released: May 28, 2002.
In 1990, GAO designated the Medicare program to be at high-risk for waste, fraud, and abuse. More than a decade later, Medicare remains on GAO's high-risk list. This report examines Medicare's claims review process, which is designed to detect improper billing or payments. GAO found that most physicians who bill Medicare are largely unaffected by carriers' medical reviews, with 90 percent of physi...
Medicare Fraud and Abuse: DOJ Has Improved Oversight of False Claims Act Guidance
GAO-01-506: Published: Mar 30, 2001. Publicly Released: Mar 30, 2001.
In June 1998, The Department of Justice (DOJ) issued guidance on the fair and responsible use of the False Claims Act in civil health care matters. This report evaluates DOJ's efforts to ensure compliance with the guidance and focuses on the application of the guidance in two recent DOJ initiatives-the Prospective Payment System (PPS) Transfer and Pneumonia Upcoding Project. GAO found that DOJ has...
Health Care Fraud: Schemes to Defraud Medicare, Medicaid, and Private Health Care Insurers
T-OSI-00-15: Published: Jul 25, 2000. Publicly Released: Jul 25, 2000.
Pursuant to a congressional request, GAO discussed the various schemes used to defraud the Medicare and Medicaid programs and private insurance companies and how the proposed legislation contained in H.R. 3461 and S.1231 could strenghten federal and state health care programs.GAO noted that: (1) in the rent-a-patient scheme, organizations pay for--or "rent"--individuals to go to clinics for unnece...
Federal Health Care: Comments on H.R. 4401, the Health Care Infrastructure Investment Act of 2000
T-AIMD-00-240: Published: Jul 11, 2000. Publicly Released: Jul 11, 2000.
Pursuant to a congressional request, GAO discussed the Health Care Infrastructure Investment Act of 2000 (H.R. 4401), which calls for the development of an immediate claim, administration, payment resolution, and data collection system, focusing on the: (1) effects of the system on the claims process of both the Medicare part B program and the Federal Employees Health Benefits Program (FEHBP); and...
Medicare Home Health Agencies: Overpayments Are Hard to Identify and Even Harder to Collect
HEHS/AIMD-00-132: Published: Apr 28, 2000. Publicly Released: May 24, 2000.
Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) oversight of the amounts of overpayments home health agencies (HHA) owe Medicare, focusing on: (1) whether HCFA quickly identifies and collects overpayments from closed HHAs; (2) the accuracy of the overpayment amounts HCFA reported for closed Texas HHAs; and (3) whether HCFA can effectively record...