Medical expense claims (1 - 10 of 68 items)
Health Insurance: Enrollment, Benefits, Funding, and Other Characteristics of State High-Risk Health Insurance Pools
GAO-09-730R: Published: Jul 22, 2009. Publicly Released: Aug 21, 2009.
A growing number of states--35 as of June 2009--have created high-risk health insurance pools (HRPs) primarily to provide coverage to individuals whose health status limits their access to coverage in the private individual health insurance market. HRPs--typically state-run nonprofit associations--often contract with a private health insurance carrier to administer the pool and offer a range of he...
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: 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...
Medicare Payments: Use of Revised 'Inherent Reasonableness' Process Generally Appropriate
HEHS-00-79: Published: Jul 5, 2000. Publicly Released: Jul 5, 2000.
Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) and the Durable Medical Equipment Regional Carriers' (DMERC) actions to implement a final rule for processing Medicare payments, focusing on whether: (1) it was proper for HCFA to issue its inherent reasonableness regulations as an interim final rule, and whether HCFA is authorized to delegate respo...
Mental Health Parity Act: Employers' Mental Health Benefits Remain Limited Despite New Federal Standards
T-HEHS-00-113: Published: May 18, 2000. Publicly Released: May 18, 2000.
GAO discussed the implementation and effects of the Mental Health Parity Act of 1996, focusing on: (1) employers' compliance with the law and the changes they have made to their health benefit plans, (2) what is known about the costs of complying with the law, and (3) the oversight roles of the Departments of Health and Human Services (HHS) and Labor (DOL) in enforcing this law.GAO noted that: (1)...
Medicare: Lessons Learned From HCFA's Implementation of Changes to Benefits
HEHS-00-31: Published: Jan 25, 2000. Publicly Released: Feb 8, 2000.
Pursuant to a congressional request, GAO provided information on the Health Care Financing Administration's (HCFA) efforts to implement changes to the Medicare program, focusing on HCFA's implementation of the: (1) expansion of the partial hospitalization benefit; and (2) more recent changes under the Balanced Budget Act of 1997 (BBA) to determine whether HCFA is acting upon lessons learned from t...
Medicare Fraud and Abuse: DOJ's Implementation of False Claims Act Guidance in National Initiatives Varies
HEHS-99-170: Published: Aug 6, 1999. Publicly Released: Aug 6, 1999.
Pursuant to a legislative requirement, GAO reviewed the Department of Justice's (DOJ) and selected U.S. Attorneys' Offices' implementation of the False Claims Act guidance, focusing on: (1) the status of DOJ's work groups efforts and the initiative-specific guidance they prepared; (2) DOJ's efforts to assess U.S. Attorneys' compliance with the guidance; (3) the implementation of the guidance at se...
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: Application of the False Claims Act to Hospital Billing Practices
HEHS-98-195: Published: Jul 10, 1998. Publicly Released: Aug 10, 1998.
Pursuant to a congressional request, GAO reviewed: (1) the False Claims Act and its application to claims involving health care programs; (2) information on the data sources, analysis, and procedures used to bring False Claims Act cases against hospitals under the 72-Hour Window Project; and (3) similar information on the Lab Unbundling Project.GAO noted that: (1) the False Claims Act was original...
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...