Medicare (81 - 90 of 335 items)
Medicare: New Spending Estimates Underscore Need for Reform
GAO-01-1010T: Published: Jul 25, 2001. Publicly Released: Jul 25, 2001.
Although the short-term outlook of Medicare's hospital insurance trust fund improved in the last year, Medicare's long-term prospects have worsened. The Medicare Trustee's latest projections, released in March, use more realistic assumptions about health care spending in the years ahead. These latest projections call into question the program's long-term financial health. The Congressional Budget...
Medicare: Successful Reform Requires Meeting Key Management Challenges
GAO-01-1006T: Published: Jul 25, 2001. Publicly Released: Jul 25, 2001.
Management of Medicare has come under increasing scrutiny. The Health Care Financing Administration (HCFA) has had mixed success running the program. The agency has developed payment methods that have contained cost growth, and HCFA has paid fee-for-service claims quickly and at low administrative cost. However, HCFA has had difficulty ensuring that it paid claims appropriately. In addition, Medic...
Regulatory Issues for Medicare Providers
GAO-01-802R: Published: Jun 11, 2001. Publicly Released: Jul 11, 2001.
Medicare is highly vulnerable to fraud, waste, and abuse. The enforcement of program payment rules, however, has raised concerns that these safeguards may have imposed too great a burden on health care providers. The proposed Medicare Education and Regulatory Fairness Act would seek to address some of these concerns by providing expedited procedures for provider appeals, new options for providers...
Medicare Contracting Reform: Opportunities and Challenges in Contracting for Claims Administration Services
GAO-01-918T: Published: Jun 28, 2001. Publicly Released: Jun 28, 2001.
Discussions about how to reform and modernize the Medicare Program have, in part, focused on whether the structure that was adopted in 1965 is optimal today. Questions have been raised about whether the program could benefit from changes to the way that Medicare's claims processing contractors are chosen and the jobs they do. Medicare could benefit from full and open competition and its relative f...
Medicare Management: Current and Future Challenges
GAO-01-878T: Published: Jun 19, 2001. Publicly Released: Jun 19, 2001.
Medicare is a popular program that millions of Americans depend on for covering their essential health needs. However, the management of the program has fallen short of expectations because it has not always appropriately balanced or satisfied the needs of beneficiaries, providers, and taxpayers. For example, stakeholders expect that Medicare will price services prudently; that providers will be t...
Medicare Subvention Demonstration: DOD's Pilot HMO Appealed to Seniors, Underscored Management Complexities
GAO-01-671: Published: Jun 14, 2001. Publicly Released: Jun 14, 2001.
This interim report reviews the implementation of the Department of Defense (DOD) Medicare Subvention Demonstration. GAO found that the demonstration sites were successful in operating Medicare managed care plans. Officials put substantial effort into meeting Medicare managed care requirements and, according to Health Care Financing Administration reviewers, were generally as successful as other n...
Medicare: Opportunities and Challenges in Contracting for Program Safeguards
GAO-01-616: Published: May 18, 2001. Publicly Released: Jun 11, 2001.
The Health Care Financing Administration (HCFA) chose 12 claims administration contractors in 1999 to act as program safeguard contractors (PSC) for Medicare. This report examines (1) HCFA's progress in implementing its PSC contracting authority and (2) whether HCFA could better manage the PSCs to ensure their most effective use. GAO found that HCFA is experimenting with different options for inte...
Medicare: Cost Sharing Policies Problematic for Beneficiaries and Program
GAO-01-713T: Published: May 9, 2001. Publicly Released: May 9, 2001.
Medicare provides valuable and extensive health care coverage for beneficiaries. Nevertheless, significant gaps leave some beneficiaries vulnerable to sizeable financial burdens from out-of-pocket expenses. Medigap is a widely available source of supplemental coverage. This testimony discusses (1) beneficiaries' potential financial liability under Medicare's current benefit structure and cost-shar...
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...
Medicare: Higher Expected Spending and Call for New Benefit Underscore Need for Meaningful Reform
GAO-01-539T: Published: Mar 22, 2001. Publicly Released: Mar 22, 2001.
Much is at stake when it comes to Medicare reform--not only the program's future but also the nation's fiscal flexibility to pursue other important national goals and programs in the future. A comprehensive effort to reform Medicare and put it on a sustainable path would help fulfill this generation's stewardship responsibility to succeeding generations. It would also help to preserve some capacit...