Health care programs (51 - 60 of 363 items)
Medicare Program Integrity: Greater Prepayment Control Efforts Could Increase Savings and Better Ensure Proper Payment
GAO-13-102: Published: Nov 13, 2012. Publicly Released: Dec 10, 2012.
Use of prepayment edits saved Medicare at least $1.76 billion in fiscal year 2010, but GAO found that savings could have been greater had prepayment edits been more widely used. GAO illustrated this point using analysis of a limited number of national policies and local coverage determinations (LCD), which are established by each Medicare administrative contractor (MAC) to specify coverage rules i...
Medicaid: Data Sets Provide Inconsistent Picture of Expenditures
GAO-13-47: Published: Oct 29, 2012. Publicly Released: Nov 29, 2012.
Medicaid expenditures in the Medicaid Statistical Information System (MSIS) were generally less than CMS-64 amounts. National expenditures in MSIS were 86, 87, and 88 percent of the amounts in CMS-64 in fiscal years 2007 through 2009, respectively. In fiscal year 2009, MSIS expenditures for states ranged from 59 to 119 percent of CMS-64. Specifically, 40 states reported lower expenditures in MSIS...
Health Care Fraud: Types of Providers Involved in Medicare Cases, and CMS Efforts to Reduce Fraud
GAO-13-213T: Published: Nov 28, 2012. Publicly Released: Nov 28, 2012.
In recently completed work, we found that medical facilities (such as medical centers, clinics, and practices) and durable medical equipment suppliers were the most frequent subjects of criminal fraud cases in Medicare, Medicaid, and CHIP in 2010. Hospitals and medical facilities were the most frequent subjects of civil fraud cases, including cases that resulted in judgments or settlements. Accord...
Medicaid: States Made Multiple Program Changes, and Beneficiaries Generally Reported Access Comparable to Private Insurance
GAO-13-55: Published: Nov 15, 2012. Publicly Released: Nov 15, 2012.
From 2008 to 2011, more than half of states reported maintaining or decreasing their average Medicaid application processing times--the average number of calendar days between the receipt of a new application and the final determination of eligibility. The average processing times reported by 39 states ranged from 11 to 45 calendar days. For the same time period, however, GAO was unable to assess...
Medicare Special Needs Plans: CMS Should Improve Information Available about Dual-Eligible Plans' Performance
GAO-12-864: Published: Sep 13, 2012. Publicly Released: Sep 19, 2012.
Why GAO Did This StudyAbout 9 million of Medicare's over 48 million beneficiaries are also eligible for Medicaid because they meet income and other criteria. These dual-eligible beneficiaries have greater health care challenges than other Medicare beneficiaries, increasing their need for care coordination across the two programs. In addition to meeting all the requirements of other MA plans, D-SNP...
Medicare Savings Programs: Implementation of Requirements Aimed at Increasing Enrollment
GAO-12-871: Published: Sep 14, 2012. Publicly Released: Sep 14, 2012.
The Social Security Administration (SSA) took a number of steps to implement the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requirements aimed at eliminating barriers to Medicare Savings Program (MSP) enrollment and spent about $12 million in fiscal years 2009 through 2011 to do so. SSA reported transferring over 1.9 million Low-Income Subsidy (LIS) program applications t...
Medicaid Program Integrity: Expanded Federal Role Presents Challenges to and Opportunities for Assisting States
GAO-12-288T: Published: Dec 7, 2011. Publicly Released: Dec 7, 2011.
The Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees Medicaid, estimated that improper payments in the federal-state Medicaid program were $21.9 billion in fiscal year 2011. The Deficit Reduction Act of 2005 established the Medicaid Integrity Program and gave CMS an expanded role in assisting and improving the effectiveness of state activities to ensure proper payme...
Foster Children: HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions
GAO-12-270T: Published: Dec 1, 2011. Publicly Released: Dec 1, 2011.
Foster children have often been removed from abusive or neglectful homes and tend to have more mental health conditions than other children. Treatment may include psychotropic drugs but their risks to children are not well understood. Medicaid, administered by states and overseen by the Department of Health and Human Services (HHS), provides prescription drug coverage to foster children. This test...
Medicaid: Prototype Formula Would Provide Automatic, Targeted Assistance to States during Economic Downturns
GAO-12-38: Published: Nov 10, 2011. Publicly Released: Nov 10, 2011.
In response to the recession of 2007, Congress passed the American Recovery and Reinvestment Act of 2009 (Recovery Act). Recovery Act funds provided states with fiscal relief and helped to maintain state Medicaid programs through a temporary increase to the federal share of Medicaid funding-the Federal Medical Assistance Percentage (FMAP)-from October 2008 through December 2010. In March 2011, GAO...
Medicare Part D: Instances of Questionable Access to Prescription Drugs
GAO-12-104T: Published: Oct 4, 2011. Publicly Released: Oct 4, 2011.
This testimony discusses the results of our investigation of fraud and prescription drug abuse in Medicare Part D. Prescription drug abuse is a serious and growing public health problem. According to the Centers for Disease Control and Prevention, drug overdoses, including those from prescription drugs, are the second leading cause of deaths from unintentional injuries in the United States, exceed...