Medicare:
Improper Handling of Beneficiary Complaints of Provider Fraud and Abuse
T-HRD-92-2: Published: Oct 2, 1991. Publicly Released: Oct 2, 1991.
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GAO discussed Medicare's responsiveness to beneficiary complaints of provider fraud and abuse, focusing on: (1) weaknesses in Medicare carriers' fraud and abuse detection efforts; and (2) the Health Care Financing Administration's (HCFA) oversight of those carrier operations. GAO noted that: (1) carriers often told beneficiaries to submit their complaints in writing or to resolve them with providers, even though the beneficiary described the complaint in detail over the telephone; (2) 15 of the 155 cases included substantial indications of potential fraud and abuse in that the provider had 2 or more similar, substantiated complaints within the last 2 years, or the current complaint, on its own, strongly suggested fraudulent or abusive behavior; (3) HCFA has not developed instructions for carrier staff on how to identify and refer complaints for investigation; (4) annual HCFA evaluations of carrier fraud and abuse detection efforts were inadequate for the five carriers reviewed; (5) carrier officials complained that they lacked sufficient resources to thoroughly investigate all complaints of provider fraud and abuse; and (6) budget reductions in the program safeguard area are undermining fraud and abuse detection activities and resulting in large program losses, but HCFA officials believe that funds for carrier personnel who answer complaints will be reallocated within the fiscal year 1992 budget.
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.
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.
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