Nursing Homes:

Too Early to Assess New Efforts to Control Fraud and Abuse

T-HEHS-97-114: Published: Apr 16, 1997. Publicly Released: Apr 16, 1997.

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GAO discussed the challenges that exist in combatting fraud and abuse in the nursing facility environment.

GAO noted that: (1) while most providers abide by the rules, some unscrupulous providers of supplies and services have used the nursing facility setting as a target of opportunity; (2) this has occurred for several reasons: (a) the complexities of the reimbursement process invite exploitation; and (b) insufficient control over Medicare claims has reduced the likelihood that inappropriate claims will be denied; (3) GAO is encouraged by a number of recent efforts to combat fraud and abuse, the pending implementation of provisions in the Health Insurance Portability and Accountability Act (HIPPA) and a legislative proposal made by the administration; and (4) while these efforts should make a difference in controlling fraud and abuse in nursing homes, it is too early to tell whether these efforts will be sufficient.

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