Medicare (21 - 30 of 486 items)
Medicaid: CMS Could Take Additional Actions to Help Improve Provider and Beneficiary Fraud Controls
GAO-15-665T: Published: Jun 2, 2015. Publicly Released: Jun 2, 2015.
GAO found thousands of Medicaid beneficiaries and hundreds of providers involved in potential improper or fraudulent payments during fiscal year 2011—the most-recent year for which reliable data were available in four selected states: Arizona, Florida, Michigan, and New Jersey. These states had about 9.2 million beneficiaries and accounted for 13 percent of all fiscal year 2011 Medicaid payments...
Medicare: Results from the First Two Years of the Pioneer Accountable Care Organization Model
GAO-15-401: Published: Apr 22, 2015. Publicly Released: May 22, 2015.
Health care providers and suppliers voluntarily form accountable care organizations (ACO) to provide coordinated care to patients with the goal of reducing spending while improving quality. Within the Centers for Medicare & Medicaid Services (CMS), the Center for Medicare & Medicaid Innovation (CMMI) began testing the Pioneer ACO Model in 2012. Under this model, ACOs can earn additional Medicare p...
Medicaid: CMS Oversight of Provider Payments Is Hampered by Limited Data and Unclear Policy
GAO-15-322: Published: Apr 10, 2015. Publicly Released: May 11, 2015.
GAO's assessment of Medicaid payments to government and private hospitals in three selected states was hampered by inaccurate and incomplete data on payments. States must capture but are not required to report all payments they make to individual institutional providers, nor are states required to report ownership information. For example, large supplemental payments states often make to hospitals...
Medicaid: A Small Share of Enrollees Consistently Accounted for a Large Share of Expenditures
GAO-15-460: Published: May 8, 2015. Publicly Released: May 8, 2015.
A small percentage of Medicaid-only enrollees—that is, those who were not also eligible for Medicare—consistently accounted for a large percentage of total Medicaid expenditures for Medicaid-only enrollees. In each fiscal year from 2009 through 2011, the most expensive 5 percent of Medicaid-only enrollees accounted for almost half of the expenditures for all Medicaid-only enrollees. In contras...
Advance Directives: Information on Federal Oversight, Provider Implementation, and Prevalence
GAO-15-416: Published: Apr 29, 2015. Publicly Released: Apr 29, 2015.
The Centers for Medicare & Medicaid Services (CMS) oversees providers' implementation of the advance directive requirement in the Patient Self Determination Act (PSDA) to maintain written policies and procedures to inform individuals about advance directives, and document information about individuals' advance directives in the medical record by providing guidance and monitoring covered providers...
Drug Discount Program: Status of GAO Recommendations to Improve 340B Drug Pricing Program Oversight
GAO-15-455T: Published: Mar 24, 2015. Publicly Released: Mar 24, 2015.
In its September 2011 report, GAO found that the Health Resources and Services Administration's (HRSA) oversight of the 340B Program was inadequate to provide reasonable assurance that program participants—covered entities and drug manufacturers—were in compliance with program requirements. Specifically, GAO found the programprimarily relied on covered entities and manufacturers to police them...
International Classification of Diseases: CMS's Efforts to Prepare for the New Version of the Disease and Procedure Codes
GAO-15-255: Published: Jan 28, 2015. Publicly Released: Feb 6, 2015.
The Centers for Medicare & Medicaid Services (CMS), within the Department of Health and Human Services (HHS), has undertaken a number of efforts to prepare for the October 1, 2015, transition to the 10th revision of the International Classification of Diseases (ICD-10) codes, which are used for documenting patient medical diagnoses and inpatient medical procedures. CMS has developed educational ma...
Health Care: Information on Coverage Choices for Servicemembers, Former Servicemembers, and Dependents
GAO-15-4: Published: Dec 12, 2014. Publicly Released: Dec 12, 2014.
Servicemembers', former servicemembers', and their dependents' eligibility for health care coverage through the Department of Defense (DOD) and the Department of Veterans Affairs (VA) is primarily based on military status, while eligibility for Medicare, Medicaid, and coverage purchased through an exchange established by the Patient Protection and Affordable Care Act (PPACA) is based on age, incom...
Medicaid: Federal Funds Aid Eligibility IT System Changes, but Implementation Challenges Persist
GAO-15-169: Published: Dec 12, 2014. Publicly Released: Dec 12, 2014.
Reported spending across all 50 states and the District of Columbia totaled more than $1.8 billion for Medicaid 90/10 funds—funds for eligibility information technology (IT) system changes—through September 30, 2014. Spending has grown steadily, with the most significant increases over the most recent quarters. According to the Centers for Medicare & Medicaid Services (CMS), 34 states used 90/...
Private Health Insurance: Concentration of Enrollees among Individual, Small Group, and Large Group Insurers from 2010 through 2013
GAO-15-101R: Published: Dec 1, 2014. Publicly Released: Dec 1, 2014.
The Patient Protection and Affordable Care Act (PPACA) requires GAO to study competition and market concentration in the health insurance market. For this study, we examined individual, small group, and large group health insurance markets prior to the implementation of key PPACA provisions that went into effect in 2014 and that could affect competition and market concentration among health insure...