High Risk Series:

Medicare Claims

HR-95-8: Published: Feb 1, 1995. Publicly Released: Feb 1, 1995.

Additional Materials:

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GAO provided information on the Health Care Financing Administration's (HCFA) efforts to implement regulatory and administrative procedures to deal with fraud and abuse in the Medicare Program.

GAO found that: (1) HCFA has established a requirement that raises the standards for contractor performance regarding analyses of payment data; (2) HCFA has awarded a contract for the development of a national automated claims processing system to replace the several systems currently operating; (3) the contractor performance requirement and the automated claims processing system are still in the early stages of development; (4) HCFA expects to reduce inappropriate Medicare payments through modern data analysis techniques and greater uniformity in claims processing; (5) some contractors that are responsible for reviewing the appropriateness of Medicare claims are also billing Medicare through their medical networks; and (6) Medicare's inability to keep pace with contractors' complicated financial arrangements raises concerns about the government's ability to protect Medicare funds in an increasingly entrepreneurial health care environment.

Below are the reports in this series:

High Risk Series: An Overview HR-95-1, Feb 1, 1995

High Risk Series: Quick Reference Guide HR-95-2, Feb 1, 1995

High Risk Series: Defense Contract Management HR-95-3, Feb 1, 1995

High Risk Series: Defense Weapons Systems Acquisition HR-95-4, Feb 1, 1995

High Risk Series: Defense Inventory Management HR-95-5, Feb 1, 1995

High Risk Series: Internal Revenue Service Receivables HR-95-6, Feb 1, 1995

High Risk Series: Asset Forfeiture Programs HR-95-7, Feb 1, 1995

High Risk Series: Medicare Claims HR-95-8, Feb 1, 1995

High Risk Series: Farm Loan Programs HR-95-9, Feb 1, 1995

High Risk Series: Student Financial Aid HR-95-10, Feb 1, 1995

High Risk Series: Department of Housing and Urban Development HR-95-11, Feb 1, 1995

High Risk Series: Superfund Program Management HR-95-12, Feb 1, 1995

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