Medicare Secondary Payer Program:

Actions Needed to Realize Savings

T-HEHS-95-92: Published: Feb 23, 1995. Publicly Released: Feb 23, 1995.

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GAO discussed legislative initiatives that are intended to improve the Medicare Secondary Payer (MSP) program, including the: (1) Health Care Financing Administration (HCFA) data match which is intended to help Medicare identify and recover costs that other insurers are responsible for paying; (2) Medicare/Medicaid data bank which is intended to identify Medicare/Medicaid beneficiaries who have other health insurance coverage; and (3) beneficiary enrollment questionnaire which is intended to identify individuals covered by other health plans that should pay claims ahead of Medicare. GAO noted that the: (1) anticipated recovery of hundreds of millions of dollars from the HCFA data match has been negated by an appeals court ruling that invalidates two HCFA regulations critical to MSP recoveries; (2) Medicare/Medicaid data bank will achieve little savings while costing millions of dollars and create an unnecessary administrative burden; and (3) the beneficiary enrollment questionnaire could potentially strengthen the MSP process and improve savings, although the actual benefits cannot yet be assessed.

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