Medicare:
Adapting Private Sector Techniques Could Curb Losses to Fraud and Abuse
T-HEHS-95-211: Published: Jul 19, 1995. Publicly Released: Jul 19, 1995.
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GAO discussed Medicare's continuing vulnerability to questionable, abusive, and exploitative provider billing. GAO noted that: (1) Medicare is vulnerable to abusive billing because it has higher-than-market rates for certain supplies and services, inadequate fraud and abuse detection procedures, inadequate criteria for confirming the authenticity of providers billing the program, and lengthy delays and inadequacies in its corrective actions; (2) the Health Care Financing Administration (HCFA) lacks the resources to review Medicare service rates; (3) contractor funding for detecting and following up on questionable claims has been declining for several years; (4) HCFA is implementing an integrated system to track each beneficiary's claims to identify suspicious activities and is exploring whether it can adopt and modify commercial software to process and pay claims; (5) few fraud and abuse cases are prosecuted and even fewer result in substantial fines or the provider being barred from the program; (6) private payers use various management approaches to prevent overcharging and to detect abusive and unqualified providers; (7) Medicare's pricing methods and utilization controls are outdated, partially due to the requirement to minimize government involvement in medical care; and (8) Medicare could save billions of dollars by pricing services and procedures more competitively, enhancing its antifraud and abuse efforts, and requiring providers to prove their suitability as Medicare vendors.
Jan 14, 2021
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Medicaid:
Data Completeness and Accuracy Have Improved, Though Not All Standards Have Been MetGAO-21-196: Published: Jan 14, 2021. Publicly Released: Jan 14, 2021.
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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