Health care programs (81 - 90 of 122 items)
Health Financing and Systems Issue Area Plan--Fiscal Years 1997-99
IAP-96-26: Published: Sep 1, 1996. Publicly Released: Sep 1, 1996.
GAO provided information on its Health Financing and Systems issue area plan for fiscal years 1997 to 1999.GAO plans to: (1) review the Health Care Financing Administration's efforts to collect payments from other insurers in the Medicare Secondary Payer program; (2) review states' ability to monitor managed care plans' financial solvency and administrative costs; (3) review managed care programs...
Blue Cross FEHBP Pharmacy Benefits
HEHS-96-182R: Published: Jul 19, 1996. Publicly Released: Aug 9, 1996.
Pursuant to a congressional request, GAO provided information on the Blue Cross and Blue Shield Association's two pharmacy benefit managers and the services they provide to federal employee benefit plans. GAO noted that: (1) to control drug costs, the Association is requiring Medicare Part B participants to pay the standard copayment for drugs bought at participating retail pharmacies, but it is w...
Medicaid Funding Formula Changes
HEHS-96-164R: Published: Jun 10, 1996. Publicly Released: Jun 10, 1996.
Pursuant to a congressional request, GAO provided information on the proposed changes to Medicaid funding formulas under H.R. 3507. GAO noted that: (1) states with large numbers of poor and disabled persons receive less federal assistance than states with larger numbers of poor and weaker tax bases; (2) states that offer extensive services and provide high provider reimbursement rates receive more...
Medicare Insured Groups
HEHS-96-93R: Published: May 1, 1996. Publicly Released: May 1, 1996.
Pursuant to a legislative requirement, GAO examined Medicare Insured Groups, focusing on: (1) the status of the demonstration program and individual projects; and (2) efforts to establish a reliable payment system. GAO found that: (1) with the passage of the Omnibus Reconciliation Act of 1987, five groups had entered into agreements with the Health Care Financing Administration (HCFA) to operate M...
Health Systems Issue Area: Active Assignments
AA-96-15(2): Published: Apr 6, 1996. Publicly Released: Apr 6, 1996.
GAO provided information on its active assignments in its Health Systems issue area as of April 6, 1996...
Medicare: Millions Can Be Saved by Screening Claims for Overused Services
T-HEHS-96-86: Published: Feb 8, 1996. Publicly Released: Feb 8, 1996.
GAO discussed how Medicare can avoid paying millions of dollars in claims for unnecessary services. GAO noted that: (1) the autoadjudicated prepayment screen is an inexpensive and compatible safeguard that is an effective and highly compatible claims processing system; (2) the 6 medical procedures reviewed are especially susceptible to overuse because few financial incentives exist for physicians...
Fraud and Abuse: Providers Target Medicare Patients in Nursing Facilities
HEHS-96-18: Published: Jan 24, 1996. Publicly Released: Feb 7, 1996.
Pursuant to a congressional request, GAO reviewed allegations of fraud and abuse related to services and supplies provided to nursing facility patients, focusing on: (1) the nature and extent of such fraud and abuse exist; (2) why nursing facility patients are an attractive target for miscreants; and (3) options for reducing fraudulent billing practices.GAO found that: (1) fraudulent and abusive b...
State Medicaid Financing Practices
HEHS-96-76R: Published: Jan 23, 1996. Publicly Released: Jan 23, 1996.
Pursuant to a congressional request, GAO provided information on state Medicaid financing arrangements in Michigan, Tennessee, and Texas. GAO noted that: (1) until the Health Care Financing Administration (HCFA) ruled in 1985 that states could use Medicaid provider donations to reduce their share of Medicaid expenditures, states could only use provider donations for the cost of training administra...
Health Financing and Public Health Issue Area: Active Assignments
AA-96-14(1): Published: Jan 2, 1996. Publicly Released: Jan 2, 1996.
GAO provided information on its active assignments in the Health Financing and Public Health issue area as of January 2, 1996...
Fraud and Abuse: Medicare Continues to Be Vulnerable to Exploitation by Unscrupulous Providers
T-HEHS-96-7: Published: Nov 2, 1995. Publicly Released: Nov 2, 1995.
GAO discussed challenges Medicare faces in battling fraud and abuse in the health care system, focusing on reasons that: (1) Medicare is an appealing target for unscrupulous providers; and (2) abusive practices persist despite efforts by program managers and law enforcement agencies. GAO noted that: (1) although most Medicare providers abide by program rules, Medicare has difficulty preventing fra...