Medicare Fraud and Abuse:

Summary and Analysis of Reforms in the Health Insurance Portability and Accountability Act of 1996 and the Balanced Budget Act of 1997

HEHS-98-18R: Published: Oct 9, 1997. Publicly Released: Oct 9, 1997.

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Pursuant to a congressional request, GAO: (1) summarized the anti-fraud and abuse reforms enacted in the Health Insurance Portability and Accountability Act (HIPAA) and Balanced Budget Act (BBA); and (2) determined whether and how the legislation responds to GAO recommendations and those of the Department of Health and Human Services (HHS) Inspector General.

GAO noted that: (1) the provisions in HIPAA and BBA offer the potential to improve program management significantly; (2) together they address Medicare's enforcement tools, payment safeguards, and pricing and payment method problems; (3) in addressing several aspects of waste, fraud, and abuse, the acts incorporate a substantial proportion of recommendations to the Congress and matters for congressional consideration; and (4) in many instances, the acts also address recommendations that GAO and the HHS Inspector General have made directly to the Department, by either emphasizing priorities or dispelling ambiguities about authority.

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