Medicaid:
HCFA and States Could Work Together to Better Ensure the Integrity of Providers
T-HEHS-00-159: Published: Jul 18, 2000. Publicly Released: Jul 18, 2000.
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Pursuant to a congressional request, GAO discussed the Health Care Financing Administration's (HCFA) efforts to better ensure the integrity of providers who bill the Medicaid program, focusing on: (1) why it is important to take steps to ensure that only honest providers bill federal health care programs; (2) what Medicare is doing to strengthen its provider enrollment process; (3) what states are doing to ensure provider integrity in the Medicaid program; and (4) what additional opportunities exist to improve these efforts.
GAO noted that: (1) with hundreds of millions of claims to process each year, Medicare and Medicaid must rely in part on provider honesty in billing; (2) as a result, it is critical to protect program funds by making efforts to ensure that only legitimate providers bill these programs; (3) recent incidents of Medicaid fraud perpetrated by dishonest medical equipment suppliers in California and other cases of Medicare and Medicaid fraud underscore these programs' vulnerability; (4) although HCFA has made revamping its provider enrollment process a priority for Medicare, it has not sought similar efforts in state Medicaid programs; (5) Medicaid state agencies report differing practices to ensure provider integrity, with only nine states reporting that they perform comprehensive provider enrollment activities; (6) because HCFA is redesigning its Medicare provider enrollment process, the HCFA Administrator has suggested that developing a joint Medicare/Medicaid provider enrollment process might be beneficial for both programs; and (7) thus, HCFA and the states have an additional opportunity to work together to develop new procedures for Medicaid that could better ensure provider integrity for both programs while minimizing the administrative burden and cost.
Mar 1, 2021
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Medicare Part B:
Payments and Use for Selected New, High-Cost DrugsGAO-21-252: Published: Mar 1, 2021. Publicly Released: Mar 1, 2021.
Feb 24, 2021
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Covid-19:
Key Insights from GAO's Oversight of the Federal Public Health ResponseGAO-21-396T: Published: Feb 24, 2021. Publicly Released: Feb 24, 2021.
Feb 17, 2021
Feb 11, 2021
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Operation Warp Speed:
Accelerated COVID-19 Vaccine Development Status and Efforts to Address Manufacturing ChallengesGAO-21-319: Published: Feb 11, 2021. Publicly Released: Feb 11, 2021.
Feb 5, 2021
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DOD Health Care:
DOD Should Monitor Implementation of Its Clinical Practice GuidelinesGAO-21-237: Published: Feb 5, 2021. Publicly Released: Feb 5, 2021. -
Medicaid:
CMS Needs to Implement Risk-Based Oversight of Puerto Rico's Procurement ProcessGAO-21-229: Published: Feb 5, 2021. Publicly Released: Feb 5, 2021. -
VA Health Care:
Community Living Centers Were Commonly Cited for Infection Control Deficiencies Prior to the COVID-19 PandemicGAO-21-195R: Published: Jan 6, 2021. Publicly Released: Feb 5, 2021.
Jan 28, 2021
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COVID-19:
Critical Vaccine Distribution, Supply Chain, Program Integrity, and Other Challenges Require Focused Federal AttentionGAO-21-265: Published: Jan 28, 2021. Publicly Released: Jan 28, 2021.
Jan 21, 2021
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Rural Hospital Closures:
Affected Residents Had Reduced Access to Health Care ServicesGAO-21-93: Published: Dec 22, 2020. Publicly Released: Jan 21, 2021. -
Health Care Funding:
Federal Obligations to and Funds Received by Certain Organizations Involved in Health-Related Services, 2016 through 2018GAO-21-188R: Published: Dec 21, 2020. Publicly Released: Jan 21, 2021.
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