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Pursuant to a congressional request, GAO discussed the Health Care Financing Administration's (HCFA) efforts to improve the measurement of improper payments in the Medicare fee-for-service program.
Recommendations for Executive Action
|Health Care Financing Administration||To improve the usefulness of measuring Medicare fee-for-service improper payments, including those attributable to potential fraud and abuse, the Administrator, HCFA, should experiment with incorporating additional techniques for detecting potential fraud and abuse into methodologies used to identify and measure improper payments and then evaluate their effectiveness. In determining the nature and extent of additional specific procedures to perform, the overall measurement approach should: (1) recognize the types of fraud and abuse perpetrated against the Medicare program; (2) consider the relative risks of potential fraud or abuse that stem from the various types of claims; (3) identify the advantages and limitations of common fraud detection techniques and use an effective combination of these techniques to detect improper payments; and (4) consider, in consultation with advocacy groups, concerns of those potentially affected by their use, including beneficiaries and health care providers.|
|Health Care Financing Administration||To improve the usefulness of measuring Medicare fee-for-service improper payments, including those attributable to potential fraud and abuse, the Administrator, HCFA, should include in the methodologies' design, sufficient scope and evaluation to more effectively identify underlying causes of improper payments to develop appropriate corrective actions.|