Medicare: Issues Concerning the HealthChoice Demonstration Project
HRD-88-69
Published: Jul 20, 1988. Publicly Released: Aug 23, 1988.
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Highlights
Pursuant to a congressional request, GAO reviewed a Health Care Financing Administration (HCFA) Medicare demonstration project to determine whether: (1) HCFA should have funded the project, which promoted private companies; (2) the contractor promoted all health maintenance organizations (HMO) equally; and (3) HCFA and the contractor properly safeguarded Medicare beneficiaries' names and addresses.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator, HCFA, not to fund additional broker projects without first reviewing HCFA authority to do so. |
Closed – Implemented
The Department of Health and Human Services (HHS) stated that it had cited the wrong legislative authority for the project. Rather than section 402(a) of the Social Security Amendments of 1967, section 1875(a) of the Social Security Act should have been used.
|
| Department of Health and Human Services | To the extent that funding authority is identified and HCFA decides to authorize projects with similar objectives, the Secretary of Health and Human Services should direct the Administrator to either not fund projects that include marketing individual HMO, or ensure that any marketing component is distinct and funded solely by the participating HMO. |
Closed – Not Implemented
HHS stated that it has no plans to fund additional projects similar to Health Choice and that the project has been concluded.
|
| Department of Health and Human Services | To the extent that funding authority is identified and HCFA decides to authorize projects with similar objectives, the Secretary of Health and Human Services should direct the Administrator to preclude use of a HCFA transmittal letter by any project or effort involving the marketing of HMO. |
Closed – Not Implemented
In commenting on a draft report, HHS stated that it believed that it should not endorse HMO enrollment and that the subject transmittal did not do so. The comments did not address what, if anything, HHS planned to do in response to the recommendation.
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| Department of Health and Human Services | To the extent that funding authority is identified and HCFA decides to authorize projects with similar objectives, the Secretary of Health and Human Services should direct the Administrator to establish written procedures for monitoring compliance with Privacy Act rules when releasing Medicare records. These procedures should assign responsibility for assuring that release agreements are properly completed. |
Closed – Implemented
In January 1989, HCFA issued a Data Release User's Guide that describes the procedures for release and safeguarding of Medicare records. HCFA assigned responsibility for releasing data and obtaining appropriate release agreements to its Privacy Act Officer.
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