Medicaid: HCFA Needs Authority to Enforce Third-Party Requirements on States
HRD-91-60
Published: Apr 11, 1991. Publicly Released: May 06, 1991.
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Highlights
Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) efforts to ensure that states paid Medicaid funds only after beneficiaries' other health care resources were exhausted, focusing on whether HCFA: (1) identified state noncompliance with federal requirements; and (2) had adequate authority to enforce compliance.
Recommendations
Matter for Congressional Consideration
Matter | Status | Comments |
---|---|---|
Congress should amend the Social Security Act to authorize HCFA to withhold federal matching funds when states do not comply with federal third-party requirements. To do so, current restrictions in the law should be removed. |
Closed – Implemented
|
States will be more likely to comply with third-party requirements as a result of the passage of related amendments in the Omnibus Budget Reconciliation Act of 1993, thereby making this recommendation less of a priority. |
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Topics
Claims processingstate relationsFines (penalties)Health insurance cost controlLaw enforcementMedical expense claimsNoncomplianceRefunds to governmentState-administered programsMedicaid