Medical expense claims (21 - 30 of 68 items)
Preventing Abusive Medicare Billing
HEHS-95-260R: Published: Sep 5, 1995. Publicly Released: Sep 5, 1995.
Pursuant to a congressional request, GAO discussed its recommendations for preventing abusive Medicare billing and whether the recommendations can be implemented legislatively. GAO noted that: (1) Medicare law could be amended to require the Department of Health and Human Services (HHS) to establish the requirements recommended, as well as establish a higher limit on the amount that Medicare will...
Medicare: Antifraud Technology Offers Significant Opportunity to Reduce Health Care Fraud
AIMD-95-77: Published: Aug 11, 1995. Publicly Released: Aug 23, 1995.
Pursuant to a congressional request, GAO provided information on how the Medicare program detects and prevents fraud, focusing on: (1) the tools Medicare uses, as well as the other available technologies, to combat fraudulent billing; and (2) rising Medicare fraud in south Florida and the actions being taken to mitigate the problem.GAO found that: (1) Medicare's controls against fraud have not kep...
Medicare: Rapid Spending Growth Calls for More Prudent Purchasing
T-HEHS-95-193: Published: Jun 28, 1995. Publicly Released: Jun 28, 1995.
GAO discussed ways in which the Medicare program could avoid excessive or unnecessary spending. GAO noted that: (1) although private payers increasingly use aggressive cost-management strategies to control health care costs, the Health Care Financing Administration (HCFA) often finds it difficult to use these strategies to control health care costs, since payment policies are established at the co...
Medicare: Reducing Fraud and Abuse Can Save Billions
T-HEHS-95-157: Published: May 16, 1995. Publicly Released: May 16, 1995.
GAO discussed the challenges in battling Medicare fraud and abuse, focusing on: (1) the ways providers exploit Medicare; and (2) how Medicare can be protected against fraud and abuse. GAO noted that: (1) Medicare is overwhelmed in its efforts to keep pace with fraud and abuse; (2) factors that make the Medicare claims system vulnerable to fraud and abuse include weak controls that detect questiona...
Medicare Claims Billing Abuse: Commercial Software Could Save Hundreds of Millions Annually
T-AIMD-95-133: Published: May 5, 1995. Publicly Released: May 5, 1995.
GAO discussed the use of commercial technology to detect Medicare billing abuses and the Health Care Financing Administration's (HCFA) efforts to develop its own capability to detect billing abuses. GAO noted that: (1) based on a statistically selected sample, commercial technology could have saved Medicare and its beneficiaries $603 million and $134 million, respectively, in fiscal year (FY) 1993...
Medicare Claims: Commercial Technology Could Save Billions Lost to Billing Abuse
AIMD-95-135: Published: May 5, 1995. Publicly Released: May 5, 1995.
Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) potential use of commercial technology to detect Medicare billing errors, focusing on whether: (1) commercial systems could reduce Medicare costs; and (2) HCFA development approach is likely to generate savings comparable to that of commercial systems.GAO found that: (1) commercial code manipulation...
Medicare: Tighter Rules Needed to Curtail Overcharges for Therapy in Nursing Homes
HEHS-95-23: Published: Mar 30, 1995. Publicly Released: Apr 19, 1995.
Pursuant to a congressional request, GAO reviewed billings for inappropriate or undelivered therapy services, focusing on overcharges to Medicare nursing home patients.GAO found that: (1) the providers responsible for overcharges for therapy services are often rehabilitation companies or nursing homes; (2) the problem of overcharging is national in scope and growing in magnitude; (3) markups on th...
High Risk Series: Medicare Claims
HR-95-8: Published: Feb 1, 1995. Publicly Released: Feb 1, 1995.
GAO provided information on the Health Care Financing Administration's (HCFA) efforts to implement regulatory and administrative procedures to deal with fraud and abuse in the Medicare Program.GAO found that: (1) HCFA has established a requirement that raises the standards for contractor performance regarding analyses of payment data; (2) HCFA has awarded a contract for the development of a nation...
Medicare/Medicaid: Data Bank Unlikely to Increase Collections From Other Insurers
HEHS-94-147: Published: May 6, 1994. Publicly Released: May 6, 1994.
GAO reviewed the Department of Health and Human Services' proposed Medicare/Medicaid data bank, focusing on whether it would: (1) improve existing Medicare and Medicaid fund recovery operations; and (2) realize greater savings beyond what the existing systems already achieve.GAO found that: (1) although Medicare and Medicaid programs could realize substantial savings if they had more complete info...
Medicare Transition System
HEHS-94-143R: Published: Apr 20, 1994. Publicly Released: Apr 20, 1994.
GAO reviewed the Health Care Financing Administration's (HCFA) plans to incorporate health care reform changes into the Medicare Transaction System (MTS), focusing on: (1) how the major health reform plans would affect the Medicare program; and (2) HCFA efforts to ensure the incorporation of health care reform provisions into MTS. GAO noted that: (1) except for the single-payer plan and the Stark...