Health maintenance organizations (11 - 20 of 61 items)
Medicare Fraud and Abuse: Summary and Analysis of Reforms in the Health Insurance Portability and Accountability Act of 1996 and the Balanced Budget Act of 1997
HEHS-98-18R: Published: Oct 9, 1997. Publicly Released: Oct 9, 1997.
Pursuant to a congressional request, GAO: (1) summarized the anti-fraud and abuse reforms enacted in the Health Insurance Portability and Accountability Act (HIPAA) and Balanced Budget Act (BBA); and (2) determined whether and how the legislation responds to GAO recommendations and those of the Department of Health and Human Services (HHS) Inspector General.GAO noted that: (1) the provisions in HI...
Private Health Insurance: Continued Erosion of Coverage Linked to Cost Pressures
HEHS-97-122: Published: Jul 24, 1997. Publicly Released: Jul 24, 1997.
Pursuant to a congressional request, GAO reviewed major trends in the private health insurance market, during the 1980s and 1990s, focusing on: (1) the decline in private health insurance coverage and factors contributing to this decline; (2) trends in health insurance premiums and reasons for these trends; and (3) employer's efforts to control health benefits costs.GAO noted that: (1) private hea...
Medicare HMOs: Setting Payment Rates Through Competitive Bidding
HEHS-97-154R: Published: Jun 12, 1997. Publicly Released: Jun 12, 1997.
GAO reviewed the Health Care Financing Administration's (HCFA) proposed use of competitive bidding as an alternative method for setting Medicare health maintenance organization (HMO) payment rates, focusing on: (1) the potential advantages of competitive bidding in the Medicare HMO program; (2) the main features of HCFA's planned competitive bidding demonstration in Denver; and (3) HMO's key objec...
Medicare Managed Care: HMO Rates, Other Factors Create Uneven Availability of Benefits
T-HEHS-97-133: Published: May 19, 1997. Publicly Released: May 19, 1997.
GAO discussed aspects of Medicare managed care, including greater choice and equity across the program, focusing on: (1) the link between counties' capitation rates and Medicare's spending on fee-for-service care; (2) factors affecting the availability of plans in a given area, the level of premiums charged, and the benefit packages offered; and (3) modifications to Medicare's current payment meth...
Health Insurance: Management Strategies Used by Large Employers to Control Costs
HEHS-97-71: Published: May 6, 1997. Publicly Released: May 14, 1997.
Pursuant to a congressional request, GAO reviewed the strategies of large, innovative purchasers who have attempted to stem the rapid escalation in health insurance costs while maintaining or enhancing the quality of care for their employees.GAO noted that: (1) several dominant themes emerged from GAO's examination of 25 large purchasers' health benefit purchasing strategies: (a) emphasis on the d...
Medicare HMOs: HCFA Can Promptly Eliminate Hundreds of Millions in Excess Payments
HEHS-97-16: Published: Apr 25, 1997. Publicly Released: May 13, 1997.
Pursuant to a congressional request, GAO provided information on Medicare's rate-setting method for paying risk contract health maintenance organizations (HMO), focusing on: (1) the conditions under which Medicare's method can yield payment rates that are too high; and (2) a practical improvement to Medicare's method directed at the problems fostering excess payments.GAO noted that: (1) contrary t...
Medicare HMO Enrollment: Area Differences Affected by Factors Other Than Payment Rates
HEHS-97-37: Published: May 2, 1997. Publicly Released: May 2, 1997.
Pursuant to a congressional request, GAO reviewed the factors affecting Medicare risk health maintenance organization (HMO) enrollment, focusing on: (1) the patterns in HMO enrollment and Medicare payment rates; (2) selected geographical areas with higher enrollment, lower payment rates and areas with lower enrollment, higher payment rates; and (3) how the presence or absence of certain factors co...
Medicare HMOs: Potential Effects of a Limited Enrollment Period Policy
HEHS-97-50: Published: Feb 28, 1997. Publicly Released: Mar 5, 1997.
Pursuant to a congressional request, GAO reviewed how a limited enrollment period would affect the Medicare program, private health plans, beneficiaries, and employers who provide Medicare supplemental benefits to retirees, focusing on: (1) the growth of Medicare's managed care program; (2) employers' attempts to administer their respective benefits seasons; (3) taxpayer savings measured against b...
Medicare: Inherent Program Risks and Management Challenges Require Continued Federal Attention
T-HEHS-97-89: Published: Mar 4, 1997. Publicly Released: Mar 4, 1997.
GAO discussed efforts to fight fraud and abuse in the Medicare program.GAO noted that: (1) it is not surprising that because of the program's size, complexity, and rapid growth, Medicare is a charter member of GAO's high risk series; (2) in this year's report on Medicare, GAO is pleased to note that both the Congress and the Health Care Financing Administration, the Department of Health and Human...
Medicare HMOs: HCFA Could Promptly Reduce Excess Payments by Improving Accuracy of County Payment Rates
T-HEHS-97-82: Published: Feb 27, 1997. Publicly Released: Feb 27, 1997.
GAO discussed the rates Medicare pays health maintenance organizations (HMO) in its risk contract program, focusing on: (1) the Health Care Financing Administration's (HCFA) method for setting HMO rates; and (2) GAO's proposed modification of HCFA's HMO rate-setting method.GAO noted that: (1) HCFA's current method of determining the county rate produces excess payments; (2) because HCFA's method e...