Medicare Secondary Payer Program:
Identifying Beneficiaries with Other Insurance Coverage Is Difficult
T-HRD-93-13: Published: Apr 2, 1993. Publicly Released: Apr 2, 1993.
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GAO discussed the Medicare secondary payer (MSP) program. GAO noted that: (1) 4 percent of Medicare beneficiaries have other primary health insurance; (2) the Health Care Financing Administration (HCFA) saved $2.8 billion when providers properly billed other insurers rather than Medicare; (3) backlogs of mistakenly paid claims have exceeded $1 billion over the past several years; (4) a data match using records from several federal agencies has helped HCFA identify over 1 million additional beneficiaries who potentially have other health insurance; (5) recent HCFA initiatives have enhanced contractors' ability to identify primary payers and avoid erroneous payments, but identification efforts are costly and dependent on accurate information; (6) HCFA current and planned MSP activities include requiring part A providers to interview beneficiaries about other insurance coverage at the time services are provided, researching beneficiaries' claims to see if they were working and had private insurance, and providing contractors with detailed information about beneficiaries' insurance coverage at the time they enroll in Medicare; (7) contractors have lacked the resources to identify and recover erroneous payments; (8) time limitations may hamper recovery of a significant portion of the contractor payments; and (9) MSP screening activities may be hampered by a conflict of interest when contractors are the primary payers for claims subject to MSP provisions.
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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