Beneficiaries (51 - 60 of 77 items)
Medicaid Managed Care: More Competition and Oversight Would Improve California's Expansion Plan
HEHS-95-87: Published: Apr 28, 1995. Publicly Released: May 15, 1995.
Pursuant to a congressional request, GAO reviewed California's Medicaid managed care program, focusing on: (1) state oversight of managed care contractors; (2) state plans for expansion; and (3) key issues in implementing the expanded program.GAO found that: (1) California plans a major expansion of its Medi-Cal managed care program in selected counties; (2) by the end of 1996, the number of enrol...
Medicare: Inadequate Review of Claims Payments Limits Ability to Control Spending
HEHS-94-42: Published: Apr 28, 1994. Publicly Released: Jun 8, 1994.
GAO reviewed the adequacy of Medicare contractors' postpayment review activities, focusing on: (1) whether the Health Care Financing Administration (HCFA) is identifying providers that are inappropriately billing the Medicare program; and (2) why Medicare spends so much for certain medical services.GAO found that: (1) HCFA does not monitor Medicare carriers' postpayment analyses and often misses o...
Medicaid: States Turn to Managed Care to Improve Access and Control Costs
HRD-93-46: Published: Mar 17, 1993. Publicly Released: Mar 17, 1993.
Pursuant to a congressional request, GAO reviewed state implementation of managed care programs, focusing on: (1) difficulties states face in implementation of certain program components; (2) the effect of the managed care approach on health care access, quality, and cost; and (3) the features that ensure the quality of health services and providers' financial stability.GAO found that: (1) from 19...
Social Security: Reforms in the Disability Determination and Appeals Process
T-HRD-91-24: Published: May 2, 1991. Publicly Released: May 2, 1991.
GAO discussed efforts to improve the initial decisionmaking process regarding social security disability claims, and to explore reasons why the Social Security Administration (SSA) allowed many claims only after administrative law judge (ALJ) hearings. GAO noted that: (1) SSA quality assurance review data indicated a decline in the quality of state disability decisions, particularly those denying...
Social Security: Employment and Health Status of Social Security Denied Applicants
T-HRD-90-48: Published: Jul 17, 1990. Publicly Released: Jul 17, 1990.
GAO discussed the health and financial status of denied social security disability applicants and commented on the disability determination process. GAO noted that: (1) in 1987, 58 percent of the applicants who were denied benefits in 1984 were not working; (2) over two-thirds of the nonworking had been out of work for at least 3 years, and 54 percent said they did not expect to ever work again; (...
Medicare Appeals Process: Part B Changes Appear to Be Fulfilling Their Purpose
HRD-90-57: Published: Jul 16, 1990. Publicly Released: Jul 16, 1990.
Pursuant to a congressional request, GAO provided information on changes in claim volume and outcomes at the carrier level following changes in the Medicare Part B appeals process.GAO found that: (1) in 1988, the Health Care Financing Administration (HCFA) required disputed Part B cases over $500 to go through a carrier hearing before appeal to an administrative law judge; (2) from January 1987 th...
Access to Medical Care at Overseas Military Hospitals
T-HRD-90-20: Published: Mar 29, 1990. Publicly Released: Mar 29, 1990.
GAO discussed military personnel and dependents access to care at six overseas military hospitals. GAO noted that: (1) access to care was a major concern at all six facilities, with particular problems in such dependent-oriented specialties as obstetrics, family practice, and pediatrics, while the orthopedic and psychiatry specialties presented access problems affecting both active-duty personnel...
Medicare: Impact of State Mandatory Assignment Programs on Beneficiaries
HRD-89-128: Published: Sep 19, 1989. Publicly Released: Oct 20, 1989.
Pursuant to a congressional request, GAO assessed the impact of four states' mandatory assignment laws, which required physicians to accept Medicare's approved amount as full payment for certain health care services, on: (1) Medicare beneficiaries' and non-beneficiaries' out-of-pocket costs; (2) physician services volume and intensity; and (3) Medicare beneficiaries' access to health care.GAO foun...
VA Health Care: Few Veterans Denied Care at Florida Clinics
HRD-89-69: Published: May 31, 1989. Publicly Released: May 31, 1989.
Pursuant to a congressional request, GAO reviewed records of 388 applications for outpatient medical care at 4 of Florida's 14 Department of Veterans Affairs' clinics to determine: (1) how many veterans were denied care; and (2) why they were denied care.GAO found that: (1) the 4 clinics denied care to 27 applicants, less than 1.4 percent of the sample; (2) the clinics typically denied care to app...