Medicare and Medicaid: More Information Exchange Could Improve Detection of Substandard Care
HRD-90-29
Published: Mar 07, 1990. Publicly Released: Mar 07, 1990.
Skip to Highlights
Highlights
GAO provided information on the Health Care Financing Administration's (HCFA) implementation of a recommendation that it develop guidelines to coordinate reporting on Medicaid and Medicare quality of care.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Health Care Financing Administration | The Administrator, HCFA, should require PRO, state Medicaid agencies, and carriers to routinely exchange information about physicians who provide unnecessary or poor-quality care. This could be accomplished through regulation and by including provisions requiring such exchanges in PRO and carrier contracts, requiring similar provisions in Medicaid state plans, and giving guidance to those entities clarifying the conditions under which such exchanges are permitted. |
Closed – Implemented
HCFA intends to require information exchange between carriers and PRO, and encourage such exchange between state Medicaid agencies and other entities. However, HCFA does not intend to require state Medicaid agencies to exchange information.
|
Full Report
Office of Public Affairs
Topics
state relationsHealth insurance cost controlInteragency relationsMedicaidMedical expense claimsMedical information systemsMedicareQuestionable paymentsReporting requirementsState-administered programsQuality of care