District Needs To Improve the Process for Identifying Misuse of Its Medicaid Program
GGD-81-78
Published: Jul 13, 1981. Publicly Released: Jul 13, 1981.
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Highlights
GAO reviewed the effectiveness of the District of Columbia's Department of Human Services (DHS) surveillance and utilization review procedures in identifying and controlling misuse and abuse of medical services.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| DC Human Services Department | The Director of the Department of Human Services should establish and implement effective procedures to require that (1) all recipients referred to the Health Education Section are counseled and (2) where appropriate, their future medical service use is monitored. Additionally, the Director should: (1) take action to implement a policy to restrict identified misusers/abusers of medical services; (2) prescribe reasonable standards and controls to assure timely processing of cases; (3) establish a system for effective reporting on the Surveillance and Utilization Review (SUR) operations; and (4) require that complete and accurate records be maintained on all cases reviewed and processed by SUR. |
Closed – Implemented
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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Topics
Collection proceduresFraudHealth care cost controlHealth care servicesManagement information systemsMonitoringProgram abusesProgram managementReports managementMedicaid