Medicare:

Post-Hearing Questions Related to Financial and Information Technology Management

GAO-01-275R: Published: Dec 21, 2000. Publicly Released: Dec 21, 2000.

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This correspondence answers congressional questions about financial and information technology management of the Medicare Program. Among the topics discussed are claims processing, management of statistical data, and computer viruses. For example, in reference to claims processing, GAO found that, as of December 2000, Medicare carriers and fiscal intermediaries use six standard claims processing systems to process Medicare part A and B claims. Each contractor relies on one of these standard systems to process its claims, and adds its own front-end and back-end processing systems. These claims processing systems date back as far as 1982. In reference to the management of statistical data, GAO found that the Health Care Financing Administration's (HCFA) common working file provides individual beneficiary claims data to HCFA's National Claims History File, which is used as the source of statistical information on Medicare and medical data. HCFA officials were unaware of any system outside HCFA from which this type of data could be obtained. Finally, regarding computer viruses, a HCFA information technology security official told GAO that the "I LOVE YOU" virus did not contaminate its systems. The official said the virus did not harm any of the workstations because HCFA's electronic mail application was not capable of executing the Visual Basic Script file, which is how the "I LOVE YOU" virus was executed. The official also said that the Melissa virus was detected and there were no incidents.

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