Medicare: HCFA Should Improve Internal Controls Over Part B Advance Payments
HRD-91-81
Published: Apr 17, 1991. Publicly Released: Apr 17, 1991.
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Highlights
GAO reviewed the Health Care Financing Administration's (HCFA) controls over Medicare internal control weaknesses, focusing on Georgia's and Florida's carriers' methods for recouping advance payments made to physicians, laboratories, and suppliers under part B regulations.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Health Care Financing Administration | The Administrator, HCFA, should determine whether it is appropriate for carriers to make advance payments to Medicare part B providers. If the Administrator determines that it is appropriate to do so, then the Administrator should develop regulations and instructions for regional offices and carriers similar to those that govern part A advance payments. Those instructions should outline the: (1) circumstances under which regional offices may authorize carriers to make advance payments; (2) method to use in calculating the payment amounts; and (3) controls that should be in place to ensure that carriers recoup such payments in a timely manner. |
Closed – Implemented
HCFA's final rule incorporating the recommendation was published September 19, 1996.
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Topics
Advance paymentsClaims processingContract performanceErroneous paymentsMedical expense claimsMedicareReporting requirementsRisk managementStandards evaluationState-administered programs