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ADP Systems: HCFA's Failure to Follow Guidelines Makes Systems Effectiveness Uncertain

IMTEC-90-53 Published: Jul 26, 1990. Publicly Released: Jul 26, 1990.
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Highlights

Pursuant to a congressional request, GAO reviewed the development, progress, performance, and cost of the Common Working File (CWF), which the Health Care Financing Administration (HCFA) implemented to improve Medicare claims processing.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services In order to ensure that CWF is cost-effective and to limit the risks inherent in developing information systems, the Secretary of Health and Human Services should direct the Administrator, HCFA, to evaluate the cost-effectiveness of continuing to operate the CWF system, and if the system is found not to be cost-effective, to determine what, if any, alternatives exist.
Closed – Implemented
The Department partially concurred with this recommendation and stated that HCFA conducts ongoing cost-effectiveness reviews and that the Inspector General is studying future alternatives.
Department of Health and Human Services In order to ensure that CWF is cost-effective and to limit the risks inherent in developing information systems, the Secretary of Health and Human Services should direct the Administrator, HCFA, to follow federal information system development standards in all future system modifications and acquisitions, seeing to it that: (1) all phases of a project's development are adequately documented; and (2) system costs and benefits are fully identified and justified;
Closed – Implemented
HCFA agreed to base the future development of CWF on established formal procedures, including federal information system development standards.

Full Report

Full Report (26 pages)

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Topics

Health Care
Claims processingCost effectiveness analysisFuture budget projectionsMedical expense claimsMedical information systemsNoncompliancePrivatizationSystems designMedicareIT acquisitions