HRP enrollment--enrollees and their dependents--totaled 199,418 in the 34 HRPs in 2008. We estimated nearly 4 million additional individuals to be potentially eligible for enrollment in an HRP based on their uninsured status and preexisting health conditions. In 2008, the average annual deductible for the most popular plan offered by each of the 34 HRPs was $1,593--almost three times as high as t

Starting in 1997 and over the next 6 years, CMS's contractors repeatedly communicated with CMS officials about escalating spending for power wheelchairs, and the contractors took steps to respond to improper payments for this Medicare benefit. In 1997, one contractor warned the agency about rapid increases in power wheelchair spending. In 1998 and in 2000, medical directors at the four contractor

Although the four contractors that process DME claims identified escalating power wheelchair spending as early as 1997, CMS did not lead a coordinated response until September 2003. Inadequate information to review claims; limited resources, which caused contractors to scale back their claims review efforts; and flaws in the process to screen suppliers before they could bill Medicare left the pro

GAO noted that: (1) HCFA acted properly in issuing an interim final rule to implement the inherent reasonableness provision of the Balanced Budget Act (BBA) because these regulations did not substantially change the factors to be considered in making inherent reasonableness determinations, and thus the criteria were met for bypassing the general requirement for issuing a notice of proposed rulema

GAO noted that: (1) most, but not all, employers that GAO surveyed reported that they comply with the law by having parity in mental health and medical and surgical annual and lifetime dollar limits; (2) among the 863 employers responding to the GAO's survey that offered mental health benefits in the 26 states and the District of Columbia with laws no more comprehensive than the federal law, the

GAO noted that: (1) HCFA has a difficult task in overseeing the implementation of changes to Medicare, yet this oversight is essential to counteract the opportunities that sometimes arise for dishonest providers to abuse the program; (2) in the early 1990s, when HCFA implemented the expansion of the partial hospitalization benefit to include community mental health centers (CMHC), HCFA did not sy

GAO noted that: (1) DOJ's national initiative work groups have made further progress in implementing the Department's False Claims Act guidance since GAO issued its February 1, 1999, report; (2) all four work groups have completed their examination of the legal and factual basis for their initiatives and have prepared initiative-specific guidance for the U.S. Attorneys' Offices participating in t

GAO noted that: (1) both SNFs and HHAs have felt the effect of the BBA provisions, and both industries will need time to adapt, but the calls to amend or repeal the new payment systems are premature; (2) the SNF prospective payment system (PPS) was implemented with a 3-year transition to the fully prospective rates, and facilities are phased into this transition schedule according to their fiscal

Pursuant to a congressional request, GAO addressed a number of issues concerning the Department of Health and Human Services' (HHS) and the Department of Justice's (DOJ) enforcement of the False Claims Act against hospitals submitting improper Medicare claims for outpatient services. GAO held that: (1) there was no evidence that errors hospitals made with respect to HHS' and DOJ's 72-hour rule we

GAO noted that: (1) the False Claims Act was originally created to help combat widespread fraud in government contracts during the Civil War; (2) amendments to the False Claims Act in 1986 strengthened the government's ability to identify and recover improper payments to federal programs; (3) the number of civil health care fraud matters pending at the Department of Justice (DOJ) at the end of th