Medical services rates (31 - 40 of 79 items)
Medicare HMOs: HCFA Could Promptly Reduce Excess Payments by Improving Accuracy of County Payment Rates
T-HEHS-97-78: Published: Feb 25, 1997. Publicly Released: Feb 25, 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...
Skilled Nursing Facilities: Approval Process for Certain Services May Result in Higher Medicare Costs
HEHS-97-18: Published: Dec 20, 1996. Publicly Released: Jan 22, 1997.
Pursuant to a congressional request, GAO reviewed: (1) the growth of skilled nursing facility (SNF) costs and SNF use in relation to hospital use; (2) the characteristics of Medicare SNF patients and the types of services they receive in SNFs being paid higher than normal amounts compared to other SNFs, as well as whether patients in such facilities receive appropriate care; and (3) whether the He...
Medicare: Early Resolution of Overcharges for Therapy in Nursing Homes Is Unlikely
HEHS-96-145: Published: Aug 16, 1996. Publicly Released: Sep 17, 1996.
Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) progress in curbing overbilling for occupational speech and physical therapy services.GAO found that: (1) therapy charges billed to Medicare by skilled nursing facilities (SNF) and rehabilitation agencies have more than doubled since 1990; (2) some providers are exploiting weaknesses in Medicare's p...
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...
Medicaid Managed Care: Serving the Disabled Challenges State Programs
HEHS-96-136: Published: Jul 31, 1996. Publicly Released: Jul 31, 1996.
Pursuant to a congressional request, GAO examined state efforts to include disabled Medicaid beneficiaries in prepaid managed care programs, focusing on the: (1) extent to which states are implementing Medicaid prepaid managed care programs for disabled beneficiaries; and (2) steps that have been taken to safeguard the interests of the stakeholder groups.GAO found that: (1) few states have signifi...
Health Insurance: Coverage of Autologous Bone Marrow Transplantation for Breast Cancer
HEHS-96-83: Published: Apr 24, 1996. Publicly Released: May 28, 1996.
Pursuant to a congressional request, GAO reviewed insurance coverage of autologous bone marrow transplantation (ABMT) for breast cancer, focusing on: (1) the factors insurers consider when deciding whether to cover treatment; (2) the effectiveness of the treatment; and (3) the consequences of the increased use and insurance coverage of the treatment while it is still in clinical trials.GAO found t...
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...
AARP Medigap Premium Increases, 1996
HEHS-96-119R: Published: Apr 19, 1996. Publicly Released: Apr 19, 1996.
Pursuant to a congressional request, GAO examined why Medigap premiums offered through the American Association of Retired Persons (AARP) were increasing. GAO noted that: (1) premiums for more than 3 million AARP Medigap policyholders increased an average of 26 percent; (2) the increases varied by state and ranged between 0 to 40 percent for both standardized and prestandardized policies; (3) in 1...
Medicare Managed Care: Growing Enrollment Adds Urgency to Fixing HMO Payment Problem
HEHS-96-21: Published: Nov 8, 1995. Publicly Released: Nov 8, 1995.
Pursuant to a congressional request, GAO reviewed Medicare payments to health maintenance organizations (HMO), focusing on: (1) current trends in Medicare beneficiary enrollment in HMO; (2) flaws in Medicare's rate-setting method that prevent it from realizing potential savings from HMO; and (3) the Health Care Financing Administration's (HCFA) efforts to test HMO payment reforms.GAO found that: (...
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...