Medicaid:
Legislation Needed to Improve Collections From Private Insurers
HRD-91-25: Published: Nov 30, 1990. Publicly Released: Jan 8, 1991.
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Pursuant to a congressional request, GAO reviewed problems that state Medicaid agencies experienced in collecting from third parties, focusing on out-of-state insurers and employee health benefit plans covered under the Employee Retirement Income Security Act of 1974 (ERISA).
GAO found that: (1) states lacked jurisdiction over insurers that operated only incidentally in the state; (2) states' limited authority over ERISA plans did not allow them to prohibit those plans from certain actions to avoid payments for recipients' covered costs; (3) state officials could not easily identify Medicaid losses through their payment systems, but federal agency information indicated that the losses could be substantial and were likely to increase; and (4) to minimize future losses, states will need federal legislation to clarify Medicaid's role as payer of last resort and enhance their ability to collect from out-of-state insurers and ERISA plans.
Matter for Congressional Consideration
Status: Closed - Implemented
Comments: The Omnibus Budget Reconciliation Act of 1993 requires states to enact laws prohibiting insurers (including group health plans under ERISA, service benefit plans, and HMOs) from taking Medicaid status into account in enrollment or payment for benefits, and to enact laws giving the state rights to payments by liable third parties, effective October 1, 1993.
Matter: Congress should amend federal law to explicitly state that Medicaid is payer of last resort, give states the authority needed to recover from all liable third parties, and provide effective mechanisms for enforcement.
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Jan 14, 2021
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Medicaid:
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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.
Dec 7, 2020
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Medicaid:
CMS Needs More Information on States' Financing and Payment Arrangements to Improve OversightGAO-21-98: Published: Dec 7, 2020. Publicly Released: Dec 7, 2020.
Dec 1, 2020
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Military Health Care:
Defense Health Agency Processes for Responding to Provider Quality and Safety ConcernsGAO-21-160R: Published: Dec 1, 2020. Publicly Released: Dec 1, 2020.
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