Medicare (1 - 10 of 63 items)
Medicare Advantage: Action Needed to Ensure Appropriate Payments for Veterans and Nonveterans
GAO-16-137: Published: Apr 11, 2016. Publicly Released: May 11, 2016.
In fiscal year 2010, the Department of Veterans Affairs (VA) health care system provided $2.4 billion in inpatient and outpatient services to the 833,684 veterans enrolled in Medicare Advantage (MA), a private plan alternative to Medicare fee-for-service (FFS). While the Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), generally pa...
Veterans' Health Care: Proper Plan Needed to Modernize System for Paying Community Providers
GAO-16-353: Published: May 11, 2016. Publicly Released: May 11, 2016.
To help ensure that veterans are provided timely and accessible health care services, the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) has purchased care from non-VA community providers through its care in the community programs since as early as 1945. VHA's agency-wide data show that in fiscal year 2015, it processed about 66 percent of claims within the agency'...
Veterans' Health Care: Preliminary Observations on VHA's Claims Processing Delays and Efforts to Improve the Timeliness of Payments to Community Providers
GAO-16-380T: Published: Feb 11, 2016. Publicly Released: Feb 11, 2016.
To help ensure that veterans are provided timely and accessible health care services, the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) has purchased care from non-VA community providers through its care in the community programs since as early as 1945. GAO's preliminary work from the sites it visited shows that in fiscal year 2015, VHA's claims processing was sig...
VA Health Care: Management and Oversight of Fee Basis Care Need Improvement
GAO-13-441: Published: May 31, 2013. Publicly Released: May 31, 2013.
The Department of Veterans Affairs' (VA) fee basis care spending increased from about $3.04 billion in fiscal year 2008 to about $4.48 billion in fiscal year 2012. The slight decrease in fiscal year 2012 spending from the fiscal year 2011 level was due to VA's adoption of Medicare rates as its primary payment method for fee basis providers. VA's fee basis care utilization also increased from about...
VA Health Care: Third-Party Collections Rising as VA Continues to Address Problems in Its Collections Operations
GAO-03-145: Published: Jan 31, 2003. Publicly Released: Mar 3, 2003.
The Department of Veterans Affairs (VA) collects health insurance payments, known as third-party collections, for veterans' health care conditions it treats that are not a result of injuries or illnesses incurred or aggravated during military service. In September 1999, VA adopted a new fee schedule, called "reasonable charges," that it anticipated would increase revenues from third-party collecti...
VA Health Care: Expanded Eligibility Has Increased Outpatient Pharmacy Use and Expenditures
GAO-03-161: Published: Nov 8, 2002. Publicly Released: Nov 8, 2002.
The Department of Veterans Affairs (VA) spent about $3.0 billion on its outpatient pharmacy benefit in fiscal year 2001. After VA implemented the Veterans' Health Care Eligibility Reform Act in 1999, more veterans could use VA outpatient care, including the pharmacy benefit, than before. Increased eligibility contributed to a doubling of the number of Priority 7 veterans using VA health care. Prio...
VA Health Care: VA Has Not Sufficiently Explored Alternatives for Optimizing Third-Party Collections
GAO-01-1157T: Published: Sep 20, 2001. Publicly Released: Sep 20, 2001.
The Department of Veterans Affairs (VA) has reversed the general decline in its third-party collections for the first time since fiscal year 1995. The fiscal year 2001 increase appears to be largely the result of VA's implementation of a new system, known as the reasonable charges billing system, which allowed VA to move from a flat-rate billing system to one that itemizes charges. However, long-s...
VA Health Care: Collections Fall Short of Expectations
T-HEHS-99-196: Published: Sep 23, 1999. Publicly Released: Sep 23, 1999.
Pursuant to a congressional request, GAO discussed the Department of Veterans Affairs' (VA) efforts to increase revenues from alternative sources as a way to supplement its medical care appropriations, focusing on trends in third-party collections.GAO noted that: (1) VA's third-party collections have declined in each of the past 3 fiscal years and may decline again by the end of fiscal year (FY) 1...
Medicare Fraud and Abuse: DOJ's Implementation of False Claims Act Guidance in National Initiatives Varies
HEHS-99-170: Published: Aug 6, 1999. Publicly Released: Aug 6, 1999.
Pursuant to a legislative requirement, GAO reviewed the Department of Justice's (DOJ) and selected U.S. Attorneys' Offices' implementation of the False Claims Act guidance, focusing on: (1) the status of DOJ's work groups efforts and the initiative-specific guidance they prepared; (2) DOJ's efforts to assess U.S. Attorneys' compliance with the guidance; (3) the implementation of the guidance at se...
Medicare Subvention: Challenges and Opportunities Facing a Possible VA Demonstration
T-HEHS/GGD-99-159: Published: Jul 1, 1999. Publicly Released: Jul 1, 1999.
Pursuant to a congressional request, GAO discussed the Department of Veterans Affairs (VA) Medicare subvention demonstration proposal, focusing on: (1) comparing the 1998 House Ways and Means Committee bill on VA subvention with the Senate Finance Committee proposal; (2) the unique characteristics of VA health care that bear on subvention; and (3) the lessons learned from the design and early impl...