Managed health care (51 - 60 of 157 items)
Medicare: Recent CMS Reforms Address Carrier Scrutiny of Physicians' Claims for Payment
GAO-02-693: Published: May 28, 2002. Publicly Released: May 28, 2002.
In 1990, GAO designated the Medicare program to be at high-risk for waste, fraud, and abuse. More than a decade later, Medicare remains on GAO's high-risk list. This report examines Medicare's claims review process, which is designed to detect improper billing or payments. GAO found that most physicians who bill Medicare are largely unaffected by carriers' medical reviews, with 90 percent of physi...
Medicare: Orthotics Ruling Has Implications for Beneficiary Access and Federal and State Costs
GAO-02-330: Published: May 22, 2002. Publicly Released: May 22, 2002.
In the late 1980s and early 1990s, the Health Care Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), became concerned that some suppliers were improperly billing Medicare for items that attach to wheelchairs and other equipment. Some suppliers were billing for such items using codes for orthodic devices, including arm, back, and neck braces that prov...
Medicare: Financial Outlook Poses Challenges for Sustaining Program and Adding Drug Coverage
GAO-02-643T: Published: Apr 17, 2002. Publicly Released: Apr 17, 2002.
The lack of outpatient prescription drug coverage may leave Medicare's most vulnerable beneficiaries with high out-of-pocket costs. Recent estimates suggest that, at any given time, more than a third of Medicare beneficiaries lack prescription drug coverage. The rest have some coverage through various sources--most commonly employer-sponsored health plans. Recent evidence indicates that this cover...
Medigap: Current Polices Contain Coverage Gaps, Undermine Cost Control Incentives
GAO-02-533T: Published: Mar 14, 2002. Publicly Released: Mar 14, 2002.
Medicare provides valuable and extensive health care coverage for 40 million elderly and disabled beneficiaries. Nevertheless, significant gaps leave some beneficiaries vulnerable to sizeable out-of-pocket expenses. Medicare provides no limit on out-of-pocket spending and no coverage for most outpatient prescription drugs. Most beneficiaries have supplemental coverage that helps to fill Medicare c...
Retiree Health Insurance: Gaps in Coverage and Availability
GAO-02-178T: Published: Nov 1, 2001. Publicly Released: Nov 1, 2001.
In 1999, about 10 million Americans aged 55 and older relied on employer-sponsored health benefits until they became eligible for Medicare or to pay for out-of-pocket expenses not covered by Medicare. However, the number of employers offering these benefits has declined considerably during the past decade. Despite the recent strong economy and the relatively low increases in health insurance premi...
Medicaid: Stronger Efforts Needed to Ensure Children's Access to Health Screening Services
GAO-01-749: Published: Jul 13, 2001. Publicly Released: Aug 13, 2001.
The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program calls for states to provide children and adolescents under age 21 with access to comprehensive, periodic evaluations of health, development, and nutritional status, as well as vision, hearing, and dental services. There is concern that state Medicaid programs are not doing an adequate job of screening children for medical...
Mental Health: Community-Based Care Increases for People With Serious Mental Illness
GAO-01-224: Published: Dec 19, 2000. Publicly Released: Dec 19, 2000.
Between 1987 and 1997, the growth in mental health spending in the United States roughly paralleled the growth in overall health care spending. However, federal mental health spending grew at more than twice the rate of state and local spending. This led to the federal government's share surpassing that of state and local governments, while the share attributable to private sources declined slight...
Medicaid Managed Care: States' Safeguards for Children With Special Needs Vary Significantly
HEHS-00-169: Published: Sep 29, 2000. Publicly Released: Oct 30, 2000.
Pursuant to a congressional request, GAO reviewed the Medicaid managed care services for children with special needs, focusing on the: (1) extent to which states are enrolling children with special needs, as defined by the Balanced Budget Act (BBA), in capitated managed care plans; and (2) scope and effectiveness of the safeguards states are implementing to ensure that children with special needs...
Medicare and Medicaid: Implementing State Demonstrations for Dual Eligibles Has Proven Challenging
HEHS-00-94: Published: Aug 18, 2000. Publicly Released: Sep 18, 2000.
Pursuant to a congressional request, GAO reviewed states' initiatives to enroll dual eligibles (beneficiaries who qualify for both Medicare and Medicaid benefits) into one managed care plan, focusing on: (1) the status and key features of state initiatives focusing on: (1) the status and key features of state initiatives to integrate care for dual-eligible beneficiaries; and (2) factors that have...
Children With Disabilities: Medicaid Can Offer Important Benefits and Services
T-HEHS-00-152: Published: Jul 12, 2000. Publicly Released: Jul 12, 2000.
Pursuant to a congressional request, GAO discussed the feasibility of allowing some families with children with disabilities to purchase Medicaid coverage, focusing on: (1) what role Medicaid plays in providing health care coverage for children with disabilities; (2) the extent to which private insurance offers coverage of needed services for children with disabilities; and (3) the benefits and se...