Medicaid (11 - 20 of 83 items)
Compounded Drugs: Payment Practices Vary across Public Programs and Private Insurers, and Medicare Part B Policy Should Be Clarified
GAO-15-85: Published: Oct 10, 2014. Publicly Released: Nov 10, 2014.
Medicare, Medicaid, and private health insurers have varying payment practices for compounded drugs, depending upon whether compounded drugs and their ingredients can be identified on health insurance claims, and Medicare's Part B payment policy for these drugs is unclear.For drugs dispensed in pharmacy settings, claims contain sufficient information for public programs and private insurers to ide...
Medicaid Payment: Comparisons of Selected Services under Fee-for-Service, Managed Care, and Private Insurance
GAO-14-533: Published: Jul 15, 2014. Publicly Released: Jul 15, 2014.
Payments to physicians under Medicaid fee-for-service (FFS) and managed care for the 26 evaluation and management (E/M) services, such as office visits and emergency care, that GAO reviewed were generally lower than private insurance prior to the temporary increases mandated by the Health Care and Education Reconciliation Act of 2010 (HCERA). Specifically, in the 40 states where GAO compared Medic...
Electronic Health Record Programs: Participation Has Increased, but Action Needed to Achieve Goals, Including Improved Quality of Care
GAO-14-207: Published: Mar 6, 2014. Publicly Released: Mar 6, 2014.
Based on the number of providers awarded incentive payments, participation in the Department of Health and Human Services' (HHS) Medicare and Medicaid Electronic Health Record (EHR) programs increased substantially from their first year in 2011 to 2012. For hospitals, participation increased from 45 percent of those eligible for 2011 to 64 percent of those eligible for 2012. For professionals, suc...
Medicaid: Use of Claims Data for Analysis of Provider Payment Rates
GAO-14-56R: Published: Jan 6, 2014. Publicly Released: Jan 6, 2014.
Among the 9 states and 35 services examined, GAO found that all states varied Medicaid payments for at least some services. However, the states differed in the number of services for which they varied payments, in the factors that accounted for variation, and in the magnitude of the variation. Many of the states varied payment rates by at least one of the factors GAO was able to explore in detail:...
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...
Medicaid: States Reported Billions More in Supplemental Payments in Recent Years
GAO-12-694: Published: Jul 20, 2012. Publicly Released: Aug 20, 2012.
States reported $32 billion in Medicaid supplemental payments during fiscal year 2010, but the exact amount of supplemental payments is unknown because state reporting was incomplete. On expenditure reports used to obtain federal funds filed with the Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS), states reported the following:A total of $17.6 bi...
Department of Health and Human Services: Opportunities for Financial Savings and Program Improvements in Medicare and Medicaid Remain
GAO-12-719T: Published: May 9, 2012. Publicly Released: May 9, 2012.
Over the past several years, GAO has made a number of recommendations to the Centers for Medicare & Medicaid Services (CMS)an agency within the Department of Health and Human Services (HHS)to increase savings in Medicare fee-for-service and Medicare Advantage (MA), which is a private plan alternative to the traditional Medicare fee-for-service program. Open recommendations that could y...
Medicare Program Integrity: CMS Continues Efforts to Strengthen the Screening of Providers and Suppliers
GAO-12-351: Published: Apr 10, 2012. Publicly Released: Apr 23, 2012.
Medicare claims are screened against enrollment information, using automated enrollment-related prepayment edits, in an effort to prevent improper payments to ineligible providers and supplierssuch as those that are no longer active in the Medicare program or are not properly licensed to provide the services for which they have submitted claims. Officials with the contractors we interviewed...
Drug Pricing: Research on Savings from Generic Drug Use
GAO-12-371R: Published: Jan 31, 2012. Publicly Released: Mar 1, 2012.
Our review identified articles that used varying approaches to estimate the savings associated with generic drug use in the United States. One group of studies estimated the savings in reduced drug costs that have accrued from the use of generics. For example, a series of studies estimated the total savings that have accrued to the U.S. health care system from substituting generic drugs for their...
Medicare Part D: Instances of Questionable Access to Prescription Drugs
GAO-12-104T: Published: Oct 4, 2011. Publicly Released: Oct 4, 2011.
This testimony discusses the results of our investigation of fraud and prescription drug abuse in Medicare Part D. Prescription drug abuse is a serious and growing public health problem. According to the Centers for Disease Control and Prevention, drug overdoses, including those from prescription drugs, are the second leading cause of deaths from unintentional injuries in the United States, exceed...