Medicare:

Reporting on the Health Care Fraud and Abuse Control Program for Fiscal Years 1998 and 1999

AIMD-00-51R: Published: Dec 13, 1999. Publicly Released: Dec 13, 1999.

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Pursuant to a legislative requirement, GAO reviewed the Health Care Fraud and Abuse Control (HCFAC) program, focusing on : (1) the amounts deposited to the Federal Hospital Insurance Trust Fund pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the sources of such amounts; (2) the amounts appropriated from the trust fund for HCFAC program and the justification for the expenditures of such amounts; (3) expenditures from the trust fund for HCFAC activities not related to Medicare; (4) any savings to the trust fund, as well as other savings, resulting from expenditures from the trust fund for the HCFAC program; and (5) other aspects of the operation of the trust fund.

GAO noted that: (1) the Departments of Health and Human Services (HHS) and Justice (DOJ) together administer the HCFAC program and are required to issue a report to Congress on January 1 of each year concerning HCFAC program activities for the preceeding fiscal year (FY); (2) they are required to report on: (a) amounts appropriated to the Federal Hospital Insurance Trust Fund pursuant to HIPAA and the source of those amounts; and (b) amounts appropriated from the trust fund for the HCFAC program and the justification for the expenditure of such amounts; (3) HHS and DOJ have issued two joint reports, covering fiscal years 1997 and 1998; (4) the next joint report, covering the FY 1999 HCFAC program, is due on January 1, 2000; (5) the joint report covering FY 1999 HCFAC program activity, which is not required to be issued until January 1, 2000, will contain information GAO needs to perform its review; (6) after receiving the joint report covering FY 1999, GAO will need time to determine what, if any, additional information is needed as well as to obtain and review that information; and (7) therefore, GAO will be unable to meet its reporting deadline of January 1, 2000, and in all likelihood, its 2002 and 2004 commitments as well.

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