Comparison of Physician Charges and Allowances Under Private Health Insurance Plans and Medicare
HRD-79-111: Published: Sep 6, 1979. Publicly Released: Sep 10, 1979.
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A comparison was made of the actual and allowed charges for physicians at four commercial and two Blue Shield Medicare carriers for their private and Medicare businesses. An assessment was also made of the Department of Health, Education, and Welfare's (HEW) use of a Medicare provision requiring that charges allowed as reasonable under Medicare not be higher than those allowed under Medicare carriers' private business for comparable services and circumstances. This provision was meant to limit program costs.
Physicians charged their private health insurance plan patients less than they charged their Medicare patients in only 9 percent of the cases sampled. In only 7 percent of the cases were the allowed charges under the private plans lower than those allowed under Medicare. Private plan allowed charges usually exceeded Medicare allowed charges by more than 10 percent. In addition, GAO found that HEW was not using the Medicare provision requiring that charges allowed as reasonable under Medicare should not be higher than those allowed under Medicare carriers' private business for comparable services under comparable circumstances. Neither the law nor HEW regulations defined what constituted comparability. Regional offices have received little guidance on this matter.
Jan 21, 2021
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Affected Residents Had Reduced Access to Health Care ServicesGAO-21-93: Published: Dec 22, 2020. Publicly Released: Jan 21, 2021.-
Health Care Funding:
Federal Obligations to and Funds Received by Certain Organizations Involved in Health-Related Services, 2016 through 2018GAO-21-188R: Published: Dec 21, 2020. Publicly Released: Jan 21, 2021.
Jan 14, 2021
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Medicaid:
Data Completeness and Accuracy Have Improved, Though Not All Standards Have Been MetGAO-21-196: Published: Jan 14, 2021. Publicly Released: Jan 14, 2021.
Jan 4, 2021
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Medicare Severe Wound Care:
Spending Declines May Reflect Site of Care Changes; Limited Information Is Available on QualityGAO-21-92: Published: Jan 4, 2021. Publicly Released: Jan 4, 2021.
Dec 22, 2020
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Defense Health Care:
Efforts to Ensure Beneficiaries Access Specialty Care and Receive Timely and Effective CareGAO-21-143: Published: Dec 22, 2020. Publicly Released: Dec 22, 2020.
Dec 16, 2020
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Medicaid Long-Term Services and Supports:
Access and Quality Problems in Managed Care Demand Improved OversightGAO-21-49: Published: Nov 16, 2020. Publicly Released: Dec 16, 2020.
Dec 14, 2020
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Drug Pricing Program:
HHS Uses Multiple Mechanisms to Help Ensure Compliance with 340B RequirementsGAO-21-107: Published: Dec 14, 2020. Publicly Released: Dec 14, 2020. -
Substance Use Disorder:
Reliable Data Needed for Substance Abuse Prevention and Treatment Block Grant ProgramGAO-21-58: Published: Dec 14, 2020. Publicly Released: Dec 14, 2020.
Dec 10, 2020
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Indian Health Service:
Actions Needed to Improve Oversight of Provider Misconduct and Substandard PerformanceGAO-21-97: Published: Dec 10, 2020. Publicly Released: Dec 10, 2020. -
Clinical Labs:
Studies Suggest Biopsy Specimen Misidentification and Contamination Errors Are InfrequentGAO-21-59: Published: Nov 10, 2020. Publicly Released: Dec 10, 2020.
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