Beneficiaries (81 - 90 of 284 items)
Medicare: Issues for Manufacturer-Level Competitive Bidding for Durable Medical Equipment
GAO-11-337R: Published: May 31, 2011. Publicly Released: Jun 29, 2011.
In 2009, Medicare--a federal health insurance program that serves about 46.3 million beneficiaries--spent approximately $8.1 billion on durable medical equipment (DME), prosthetics, orthotics, and related supplies for 10.6 million beneficiaries. DME includes items such as wheelchairs, hospital beds, and walkers. Medicare beneficiaries typically obtain DME items from suppliers, who submit claims fo...
Medicare Secondary Payer: Process for Situations Involving Non-Group Health Plans
GAO-11-726T: Published: Jun 22, 2011. Publicly Released: Jun 22, 2011.
The Centers for Medicare & Medicaid Services (CMS) is responsible for protecting the Medicare program's fiscal integrity and ensuring that it pays only for those services that are its responsibility. Medicare Secondary Payer (MSP) provisions make Medicare a secondary payer to certain group health plans (GHP) and non-group health plans (NGHP), which include auto or other liability insurance, no-fau...
Defense Health Care: Access to Civilian Providers under TRICARE Standard and Extra
GAO-11-500: Published: Jun 2, 2011. Publicly Released: Jun 2, 2011.
The Department of Defense (DOD) provides health care through its TRICARE program, which is managed by the TRICARE Management Activity (TMA). TRICARE offers three basic options. Beneficiaries who choose TRICARE Prime, an option that uses civilian provider networks, must enroll. TRICARE beneficiaries who do not enroll in this option may obtain care from nonnetwork providers under TRICARE Standard or...
End-Stage Renal Disease: CMS Should Assess Adequacy of Payment When Certain Oral Drugs Are Included and Ensure Availability of Quality Monitoring Data
GAO-11-365: Published: Mar 23, 2011. Publicly Released: Mar 23, 2011.
For most individuals with end-stage renal disease (ESRD), Medicare purchases a bundle of dialysis-related services using a single payment. In 2014, the Centers for Medicare & Medicaid Services (CMS) plans to include in this bundled payment "oral-only" ESRD drugs used to treat mineral and bone disorder. Currently, Medicare generally pays for these drugs only if the beneficiary has Part D prescripti...
Medicare Home Oxygen: Refining Payment Methodology Has Potential to Lower Program and Beneficiary Spending
GAO-11-56: Published: Jan 21, 2011. Publicly Released: Feb 14, 2011.
Studies have found that Medicare payment rates for home oxygen exceeded other payers' rates. Congress has reduced home oxygen payment rates, capped rental payments after 36 months, and directed the Centers for Medicare & Medicaid Services (CMS), which administers Medicare, to use competitive bidding. GAO was asked to examine Medicare home oxygen payment policy. GAO describes how Medicare pays for...
Medicare Advantage: Comparison of Plan Bids to Fee-for-Service Spending by Plan and Market Characteristics
GAO-11-247R: Published: Feb 4, 2011. Publicly Released: Feb 10, 2011.
While most of Medicare's 46 million beneficiaries are covered by the traditional fee-for-service (FFS) program, about one in four beneficiaries receives benefits through private health plans under the Medicare Advantage (MA) program. Under the FFS program, Medicare pays health care providers for each covered service they furnish. While Medicare sets the price it pays, the volume of services--and,...
Medicare: CMS Needs to Collect Consistent Information from Quality Improvement Organizations to Strengthen Its Establishment of Budgets for Quality of Care Reviews
GAO-11-116R: Published: Dec 6, 2010. Publicly Released: Dec 22, 2010.
Medicare funds health care services for more than 46 million beneficiaries. The Centers for Medicare & Medicaid Services (CMS)--the agency that administers Medicare--contracts with private organizations known as Quality Improvement Organizations (QIO) to, among other core functions, improve the quality of care for Medicare beneficiaries. CMS contracts with one QIO for each of the 50 states, the Di...
Medicare Advantage: CMS Actions Regarding Plans' Health Reform Communications
GAO-10-953R: Published: Sep 20, 2010. Publicly Released: Oct 13, 2010.
In August and September 2009, Humana--a large private health insurer--sent a letter to the approximately 930,000 beneficiaries enrolled in its Medicare Advantage (MA) plans, advising that leading health reform proposals could adversely affect MA beneficiaries. Signed by Humana's Chief Medical Officer, the letter stated that if proposed funding cuts became law, "millions of seniors and disabled ind...
Medicare: CMS Has Addressed Some Implementation Problems from Round 1 of the Durable Medical Equipment Competitive Bidding Program for the Round 1 Rebid
GAO-10-1057T: Published: Sep 15, 2010. Publicly Released: Sep 15, 2010.
To reduce spending on durable medical equipment (DME) and related items, under federal law the Centers for Medicare & Medicaid Services (CMS) is phasing in, with several rounds of bidding, a competitive bidding program (CBP) for certain DME and other items. Because of numerous concerns, the Medicare Improvements for Patient and Providers Act of 2008 (MIPPA) terminated the CBP round 1 supplier cont...
Medicare Fraud, Waste, and Abuse: Challenges and Strategies for Preventing Improper Payments
GAO-10-844T: Published: Jun 15, 2010. Publicly Released: Jun 15, 2010.
GAO has designated Medicare as a high-risk program since 1990, in part because the program's size and complexity make it vulnerable to fraud, waste, and abuse. Fraud represents intentional acts of deception with knowledge that the action or representation could result in an inappropriate gain, while abuse represents actions inconsistent with acceptable business or medical practices. Waste, which i...