Improper Hospital Charges for Priority Tests Claimed for Medicare Reimbursement
HRD-83-36
Published: Jan 13, 1983. Publicly Released: Jan 13, 1983.
Skip to Highlights
Highlights
GAO is currently reviewing ancillary service utilization to assess the reasonableness and medical necessity of ancillary services claimed for Medicare reimbursement.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | The Secretary of HHS should direct the Administrator, HCFA, to specifically address the nonallowability of stat charges in the Medicare Provider Reimbursement Manual. |
Closed – Not Implemented
HCFA does not intend to act on the recommendation because of the Medicare prospective payment system. Although GAO does not agree with this reason, it will not pursue the recommendation because the amount involved is relatively small.
|
| Department of Health and Human Services | The Secretary of HHS should direct the Administrator, HCFA, to require intermediary auditors to spot check for the inclusion of stat charges during their onsite audits of hospitals. |
Closed – Not Implemented
HCFA does not intend to implement this recommendation. In addition, HCFA is not implementing the other recommendation which would be necessary to make this one work.
|
Full Report
Office of Public Affairs
Topics
Hospital care servicesMedical services ratesQuestionable paymentsMedicareHospitalsHealth careHealth care financeHuman capital managementMedical recordsAudits