Medical expense claims (31 - 40 of 64 items)
Use of False Claims Act for Medicare Outpatient Claims Cases
B-279893: Published: Jul 22, 1998. Publicly Released: Aug 26, 1998.
Pursuant to a congressional request, GAO addressed a number of issues concerning the Department of Health and Human Services' (HHS) and the Department of Justice's (DOJ) enforcement of the False Claims Act against hospitals submitting improper Medicare claims for outpatient services. GAO held that: (1) there was no evidence that errors hospitals made with respect to HHS' and DOJ's 72-hour rule wer...
Medicare: Fraud and Abuse Control Pose a Continuing Challenge
HEHS-98-215R: Published: Jul 15, 1998. Publicly Released: Jul 15, 1998.
Pursuant to a congressional request, GAO reviewed fraud and abuse in both Medicare's fee-for-service and managed care programs, focusing on: (1) the impact of inadequate program safeguard funding on efforts to combat improper Medicare payments; (2) ineffective management and oversight of fee-for-service payments and operations; and (3) ineffective oversight of Medicare managed care plans.GAO noted...
Medicare Managed Care Appeal Process for Denials of Care: A Comparison With Recommendations From the President's Quality Commission
HEHS-98-155R: Published: May 8, 1998. Publicly Released: Jun 8, 1998.
Pursuant to a congressional request, GAO reviewed information on Medicare managed care appeals to help Congress consider legislation on national appeal rights for private-sector health care consumers, focusing on: (1) comparing the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry's recommended appeal process with that required by the Medicare program;...
State Mandated Benefits
HEHS-96-125R: Published: Apr 15, 1996. Publicly Released: Apr 15, 1996.
Pursuant to a congressional request, GAO provided information on state regulation of health plans, particularly mandated health insurance benefit laws. GAO noted that: (1) the number and type of mandated benefits vary by state, but they range from 6 to 39 and average 18 per state; (2) states most frequently mandate the coverage of preventive care and some states mandate coverage of services by non...
Medicare Secondary Payer Program: Actions Needed to Realize Savings
T-HEHS-95-92: Published: Feb 23, 1995. Publicly Released: Feb 23, 1995.
GAO discussed legislative initiatives that are intended to improve the Medicare Secondary Payer (MSP) program, including the: (1) Health Care Financing Administration (HCFA) data match which is intended to help Medicare identify and recover costs that other insurers are responsible for paying; (2) Medicare/Medicaid data bank which is intended to identify Medicare/Medicaid beneficiaries who have ot...
Medicare and Medicaid: Many Eligible People Not Enrolled in Qualified Medicare Beneficiary Program
HEHS-94-52: Published: Jan 20, 1994. Publicly Released: Jan 25, 1994.
Pursuant to a congressional request, GAO reviewed: (1) government efforts to publicize the Qualified Medicare Beneficiary (QMB) program; and (2) suggestions for increasing enrollment in QMB.GAO found that: (1) 2 million people eligible for the QMB program did not enroll in the program in 1991; (2) federal and state efforts to publicize the QMB program have not had a significant effect on the QMB e...
Health Insurance: Remedies Needed to Reduce Losses From Fraud and Abuse
T-HRD-93-8: Published: Mar 8, 1993. Publicly Released: Mar 8, 1993.
GAO discussed health care fraud and abuse and the need for better remedies and more resources to combat the problem. GAO noted that: (1) fraud and abuse encompassed a wide range of improper billing practices by physicians, medical equipment suppliers, and other suppliers that add 10 percent to U.S. health care costs; (2) whether or not health care insurers pursued a fraudulent act depended on the...
Health Insurance: Legal and Resource Constraints Complicate Efforts to Curb Fraud and Abuse
T-HRD-93-3: Published: Feb 4, 1993. Publicly Released: Feb 4, 1993.
GAO discussed health care fraud and abuse issues, focusing on: (1) the size and nature of health insurance fraud and abuse; and (2) resource and other problems associated with investigation and prosecution. GAO noted that: (1) health care insurance fraud and abuse contributed an estimated 10 percent to U.S. health care costs; (2) problems in combatting health insurance fraud and abuse include lega...
District of Columbia: Barriers to Medicaid Enrollment Contribute to Hospital Uncompensated Care
HRD-93-28: Published: Dec 29, 1992. Publicly Released: Jan 28, 1993.
Pursuant to a congressional request, GAO reviewed the District of Columbia's (DC) Medicaid program and uncompensated hospital care in DC, focusing on the: (1) extent of DC hospitals' problems with uncompensated care; (2) Medicaid enrollment process and its relationship to Medicaid reimbursement and uncompensated care; and (3) potential barriers to enrollment in the DC Medicaid enrollment process.G...
Medicaid: Disproportionate Share Policy
HRD-93-3R: Published: Dec 22, 1992. Publicly Released: Jan 22, 1993.
Pursuant to a congressional request, GAO reviewed the Medicaid disproportionate share program, focusing on: (1) how states designate disproportionate share hospitals and formula used to reimburse the hospitals; (2) the impact of charity care on state disproportionate share formula; and (3) Texas' experience with the program. GAO found that: (1) states have a significant amount of control over whic...