Medicare (51 - 60 of 63 items)
Expanded Federal Authority Needed To Protect Medicare and Medicaid Patients From Health Practitioners Who Lose Their Licenses
HRD-84-53: Published: May 1, 1984. Publicly Released: May 1, 1984.
GAO obtained information on health care practitioners in three states who had their licenses revoked or suspended to determine whether they were relocating and continuing to treat patients under Medicaid and Medicare programs in other states.GAO found that, when a state licensing board revokes or suspends a practitioner's license, Medicare and Medicaid are informed that he can no longer legally pr...
The Need for Expanded Federal Exclusion Authority
124022: May 1, 1984
Testimony was given on the need to expand the Federal Government's authority to exclude unfit health care practitioners from the Medicare and Medicaid programs to help ensure that program recipients receive quality care. GAO found that it is possible for medical practitioners who hold licenses in more than one State to have one of these licenses suspended or revoked by a State licensing board but...
Review of Medicare and Medicaid Duplicate Payments in Michigan
HRD-83-43: Published: Feb 22, 1983. Publicly Released: Feb 22, 1983.
GAO reviewed the practices and procedures of the Michigan Medicare carrier and Medicaid administrator to prevent duplicate payments to physicians with more than one provider identification number and to remove unlicensed physicians from the Medicare and Medicaid rolls.GAO found that: (1) duplicate payments of about $39,000 were made to Medicare providers with multiple-provider numbers; (2) duplica...
Prospective Payment Systems for Nursing Home Care
120522: Feb 4, 1983
In 1982, Congress mandated that the Department of Health and Human Services develop legislative proposals to provide for reimbursing skilled nursing facilities prospectively under Medicare. GAO believes that the State Medicaid systems for prospective reimbursement should be examined when developing the Federal Medicare system. Under the prospective reimbursement system developed in Texas, the per...
Preliminary Findings on Patient Characteristics and State Medicaid Expenditures for Nursing Home Care
IPE-82-4: Published: Jul 15, 1982. Publicly Released: Jul 16, 1982.
In response to a congressional request, GAO presented preliminary findings on State nursing home expenditures and the characteristics of patients in nursing homes. Congress is reviewing proposed changes in the inspection and certification procedures for nursing homes.Current inspection and certification procedures are designed to insure that nursing homes with Medicaid and Medicare residents meet...
Guidance and Information Needed on the Use of Machine Readable Claims Under Medicare and Medicaid
HRD-82-30: Published: Dec 16, 1981. Publicly Released: Dec 16, 1981.
GAO surveyed the: (1) extent that Medicare and Medicaid providers use machine readable claims and billing service companies; and (2) implications of their use on claims processing agent operations such as administrative costs, utilization and quality control reviews, and reimbursement determinations. GAO was also interested in whether there were any potential conflicts of interest between claims p...
Programs To Control Prescription Drug Costs Under Medicaid and Medicare Could Be Strengthened
HRD-81-36: Published: Dec 31, 1980. Publicly Released: Jan 30, 1981.
The Department of Health and Human Services (HHS) established two programs to contain the costs of prescription drugs under Medicaid and Medicare by setting upper limits on the amounts that could be reimbursed. One program, the Maximum Allowable Cost (MAC) Program, pertains to multiple-source drugs and is applicable to Medicaid and Medicare. The other program, the Estimated Acquisition Cost (EAC)...
Rising Hospital Costs Can Be Restrained by Regulating Payments and Improving Management
HRD-80-72: Published: Sep 19, 1980. Publicly Released: Sep 19, 1980.
GAO examined the impact on rising hospital costs in nine States having prospective rate-setting programs. Prospective rate-setting programs depart from the traditional cost-based retrospective method of paying for hospital services, and instead, make payments based on rates determined before the services are provided.Twenty-six States have adopted various prospective ratesetting programs These pro...
Evaluation of the Health Care Financing Administration's Proposed Home Health Care Reimbursement Limits
HRD-80-84: Published: May 8, 1980. Publicly Released: May 13, 1980.
In response to congressional concern that the limits proposed by the Health Care Financing Administration (HCFA) on home health care reimbursements were too high, GAO reviewed the accuracy of the database used to develop the limits, the methodology used, the accuracy of the HCFA estimated savings, and alternative methods HCFA could use to improve existing limits or develop subsequent home health r...
Investigations of Medicare and Medicaid Fraud and Abuse--Improvements Needed
HRD-77-19: Published: May 23, 1977. Publicly Released: May 23, 1977.
Investigations of the Department of Health, Education, and Welfare (HEW) into potential Medicare fraud and abuse cases, identified from Medicare contractors' internal control systems were reviewed. Also reviewed were Medicaid fraud and abuse investigations carried out by two states, Missouri and California.Investigations of Medicare fraud and abuse were weak in that some complaints were prematurel...