HCFA to Strengthen Medicare Provider Enrollment Significantly, but Implementation Behind Schedule

GAO-01-114R: Published: Nov 2, 2000. Publicly Released: Nov 2, 2000.

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One of the first defenses against improper Medicare billings is the screening of applications from providers seeking to participate in the program. The Health Care Financing Administration (HCFA) operates and manages the Medicare program and, with help from insurance companies, reviews provider applications to determine whether providers meet Medicare requirements and if there is a reason to suspect that providers' future Medicare billings would be improper. GAO found that HCFA's current provider enrollment process does not completely ensure that dishonest and unqualified providers are prevented from obtaining Medicare billing privileges. GAO suggests consolidating provider enrollment tasks with fewer contractors to strengthen HCFA's ability to oversee these contractors and enhance the efficiency of the enrollment process. HCFA is implementing several changes to its provider enrollment processes that may make it more difficult for dishonest providers to enroll in Medicare; however, delays in implementing these initiatives will also postpone their benefits.

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