Recommendations for Executive Action

1. Status: Closed - Implemented

   Comments: In October 1984, HCFA issued instructions to the carriers requiring them to screen claims for once-in-a-lifetime procedures.

   Recommendation: The Administrator, HCFA, should enforce the requirement that carriers implement controls for once-in-a-lifetime procedures.

   Agency Affected: Department of Health and Human Services: Health Care Financing Administration

2. Status: Closed - Implemented

   Comments: In June 1984, HCFA directed the carriers to pursue the overpayments. The carriers reported, in August 1984, that collections had been made.

   Recommendation: The Administrator, HCFA, should require the Equitable Life Assurance Society to collect all of the overpayments for dialysis treatments that were identified.

   Agency Affected: Department of Health and Human Services: Health Care Financing Administration

3. Status: Closed - Implemented

   Comments: HCFA is developing a core list of once-in-a-lifetime procedures.

   Recommendation: The Administrator, HCFA, should develop a core list of codes to be controlled as once-in-a-lifetime procedures while implementing the HCFA Common Procedure Coding System and require carriers to have edits for these procedures.

   Agency Affected: Department of Health and Human Services: Health Care Financing Administration

4. Status: Closed - Implemented

   Comments: HCFA is still studying the desirability of requiring carriers, as a permanent part of a beneficiary's record, to note the performance of once-in-a-lifetime procedures.

   Recommendation: The Administrator, HCFA, should examine the desirability of requiring carriers to make use of procedures that can only be performed once on a beneficiary a permanent part of beneficiaries' records.

   Agency Affected: Department of Health and Human Services: Health Care Financing Administration

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