Medicaid (51 - 60 of 486 items)
CMS: Activities, Staffing, and Funding for the Center for Strategic Planning
GAO-13-377R: Published: Apr 1, 2013. Publicly Released: May 1, 2013.
CSP's activities, staff, and funding support strategic planning by individual CMS offices and centers as well as the agency itself. CMS officials told us that CSP assists individual offices and centers in developing strategic plans for their units, leads the agency's senior-level strategic planning meetings, and is helping to develop a centralized approach to monitor the implementation of CMS's ag...
Medicaid: Enhancements Needed for Improper Payments Reporting and Related Corrective Action Monitoring
GAO-13-229: Published: Mar 29, 2013. Publicly Released: May 1, 2013.
The Centers for Medicare & Medicaid Services' (CMS) methodology for estimating a national improper payment rate for the Medicaid program is statistically sound. However, CMS's procedures did not provide for updating state data used in its methodology to recognize significant corrections or adjustments after the cutoff date. The Office of Management and Budget (OMB) requires that federal agencies e...
GAO's 2013 High-Risk Update: Medicare and Medicaid
GAO-13-433T: Published: Feb 27, 2013. Publicly Released: Feb 27, 2013.
Medicare Program: CMS has not met GAO's criteria to have the Medicare program removed from the High-Risk List. For example, although CMS has made progress in measuring and reducing improper payment rates in different parts of the program, it has yet to demonstrate sustained progress in lowering the rates. Because the size of Medicare relative to other programs leads to aggregate improper payments...
Medicaid: More Transparency of and Accountability for Supplemental Payments Are Needed
GAO-13-48: Published: Nov 26, 2012. Publicly Released: Dec 21, 2012.
The recently implemented annual audits and reports for states' disproportionate share hospital (DSH) payments could improve oversight by the Centers for Medicare & Medicaid Services (CMS)--the federal agency that oversees Medicaid--by illuminating needed changes. States are required to submit audits and reports to CMS as a condition for receiving federal funds for their DSH payments. The first set...
CMS Innovation Center: Early Implementation Efforts Suggest Need for Additional Actions to Help Ensure Coordination with Other CMS Offices
GAO-13-12: Published: Nov 15, 2012. Publicly Released: Dec 17, 2012.
From the time it became operational in November 2010, through March 31, 2012, the Center for Medicare and Medicaid Innovation (Innovation Center) has focused on implementing 17 new models to test different approaches for delivering or paying for health care in Medicare and Medicaid. The center is still relatively early in the process of implementing these models. Eleven of the models were selected...
Electronic Health Records: Number and Characteristics of Providers Awarded Medicaid Incentive Payments for 2011
GAO-13-146R: Published: Dec 13, 2012. Publicly Released: Dec 13, 2012.
In summary, 1,964 hospitals and 45,962 professionals were awarded a total of approximately $2.7 billion in Medicaid EHR incentive payments for 2011. These 1,964 hospitals, which represented 39 percent of the 5,013 eligible hospitals, were awarded a total of $1.7 billion in Medicaid EHR incentive payments for 2011. While the amount of Medicaid EHR incentive payments awarded to each hospital ranged...
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...
Medicare and Medicaid: Consumer Protection Requirements Affecting Dual-Eligible Beneficiaries Vary across Programs, Payment Systems, and States
GAO-13-100: Published: Dec 5, 2012. Publicly Released: Dec 5, 2012.
Medicare and Medicaid consumer protection requirements vary across programs, payment systems--either fee-for-service (FFS) or managed care--and states. Within Medicare, enrollment in managed care through the Medicare Advantage (MA) program must always be voluntary, whereas state Medicaid programs can require enrollment in managed care in certain situations. For example, Arizona requires nearly all...
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...
Medicare Fraud Prevention: CMS Has Implemented a Predictive Analytics System, but Needs to Define Measures to Determine Its Effectiveness
GAO-13-104: Published: Oct 15, 2012. Publicly Released: Nov 15, 2012.
The Centers for Medicare and Medicaid Services (CMS) implemented its Fraud Prevention System (FPS) in July 2011, as required by the Small Business Jobs Act, and the system is being used by CMS and its program integrity contractors who conduct investigations of potentially fraudulent claims. Specifically, FPS analyzes Medicare claims data using models of fraudulent behavior, which results in automa...