Medicare:
PRO Review Does Not Assure Quality of Care Provided by Risk HMOs
T-HRD-91-12: Published: Mar 13, 1991. Publicly Released: Mar 13, 1991.
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GAO discussed peer review organizations' (PRO) effectiveness in assessing the quality of care Medicare beneficiaries received at health maintenance organizations (HMO). GAO noted that: (1) the Health Care Financing Administration's (HCFA) PRO review program did not ensure that Medicare beneficiaries received adequate care; (2) HCFA did not ensure that internal quality assurance programs effectively identified and corrected quality-of-care problems; (3) HCFA made PRO review optional for some HMO, and most HMO elected not to have their quality assurance activity reviewed by PRO; (4) PRO external medical records review did not provide a valid quality-of-care assessment, since PRO did not have access to comprehensive HMO data from which to select their review samples; (5) HCFA did not use PRO review results in its own HMO compliance monitoring process; (6) HCFA recently proposed a new PRO review methodology to correct some of the identified problems; and (7) the HCFA proposal did not address the underlying data problems of the PRO/HMO review program.
Jan 21, 2021
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.
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.
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