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Health Care (11 - 20 of 4,926 items)
Medicaid: Program Oversight Hampered by Data Challenges, Underscoring Need for Continued Improvements
GAO-17-173: Published: Jan 6, 2017. Publicly Released: Feb 6, 2017.
GAO found that available Medicaid expenditure and utilization data do not provide CMS with sufficient information to consistently ensure that payments are proper or that beneficiaries have access to covered services. The Centers for Medicare & Medicaid Services (CMS), the agency within the Department of Health and Human Services (HHS) that administers the Medicaid program, relies on two key data s...
Medicaid: CMS Has Taken Steps, but Further Efforts Are Needed to Control Improper Payments
GAO-17-386T: Published: Jan 31, 2017. Publicly Released: Jan 31, 2017.
GAO's prior work has identified four Medicaid program integrity issues—where the program is vulnerable to improper payments such as those made for services that were not covered, were not medically necessary, or were not provided—as well as actions taken by the Centers for Medicare & Medicaid Services (CMS) to address the issues and additional actions that should be taken.Enrollment Verificati...
Patient Protection and Affordable Care Act: Concentration, Plan Availability and Premiums, and Enrollee Experiences in Health Insurance Markets Since 2014
GAO-17-383T: Published: Jan 31, 2017. Publicly Released: Jan 31, 2017.
GAO issued three reports in 2015 and 2016 on the early impact of the Patient Protection and Affordable Care Act (PPACA) on private health insurance markets.Market ConcentrationIn a 2016 report, GAO examined enrollment in private health-insurance plans in the years leading up to and through 2014, the first year of the exchanges established by PPACA, and found that in all years analyzed, markets wer...
Military Personnel: DOD and the Coast Guard Need to Screen for Gambling Disorder Addiction and Update Guidance
GAO-17-114: Published: Jan 30, 2017. Publicly Released: Jan 30, 2017.
Department of Defense (DOD) data show 514 DOD and Coast Guard (CG) active-duty servicemembers and 72 Reserve Component servicemembers—less than 0.03 percent of the average number of servicemembers in each year—were diagnosed with gambling disorder or were seen for problem gambling in fiscal years 2011 through 2015 in the Military Health System (MHS). The MHS provides health services to benefic...
Federal Health Care Center: VA and DOD Need to Develop Better Information to Monitor Operations and Improve Efficiency
GAO-17-197: Published: Jan 23, 2017. Publicly Released: Jan 23, 2017.
The Department of Veterans Affairs (VA) and the Department of Defense's (DOD) evaluation to determine whether the Captain James A. Lovell Federal Health Care Center (FHCC) should continue operating as an integrated facility or revert to a “joint venture” included conducting both separate and joint reviews. As an integrated facility, the FHCC has a unified governance structure, workforce, and b...
Veterans Health Administration: Management Attention Is Needed to Address Systemic, Long-standing Human Capital Challenges
GAO-17-30: Published: Dec 23, 2016. Publicly Released: Jan 23, 2017.
The Veterans Health Administration's (VHA) limited human resources (HR) capacity combined with weak internal control practices has undermined VHA's HR operations and its ability to improve delivery of health care services to veterans.Attrition of medical center HR staff increased between fiscal years 2013 and 2015, due to HR staff transferring to other federal agencies. VHA officials note a lack o...
Medicare Advantage: Limited Progress Made to Validate Encounter Data Used to Ensure Proper Payments
GAO-17-223: Published: Jan 17, 2017. Publicly Released: Jan 19, 2017.
Since GAO issued its July 2014 report, the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS) has made limited progress to validate the completeness and accuracy of Medicare Advantage (MA) encounter data. CMS collects encounter data—detailed information about the care and health status of MA enrollees—to determine payments to MA organization...
National Institutes of Health: Kidney Disease Research Funding and Priority Setting
GAO-17-121: Published: Dec 19, 2016. Publicly Released: Jan 18, 2017.
The National Institutes of Health (NIH), within the Department of Health and Human Services, is the primary federal agency that conducts biomedical research on kidney disease, as well as various other diseases and conditions. NIH's budget—$30 billion in fiscal year 2015—mostly funds extramural research that supports research personnel working at universities, medical schools, and other institu...
Drug Safety: FDA Has Improved Its Foreign Drug Inspection Program, but Needs to Assess the Effectiveness and Staffing of Its Foreign Offices
GAO-17-143: Published: Dec 16, 2016. Publicly Released: Jan 17, 2017.
The Food and Drug Administration (FDA), an agency within the Department of Health and Human Services (HHS), has increased its foreign drug inspections and enhanced its ability to prioritize drug establishments for inspection. The number of foreign inspections has consistently increased each year since fiscal year 2009. Beginning in fiscal year 2015, FDA conducted more foreign than domestic inspect...
Indian Health Service: Actions Needed to Improve Oversight of Quality of Care
GAO-17-181: Published: Jan 9, 2017. Publicly Released: Jan 9, 2017.
The Indian Health Service's (IHS) oversight of the quality of care provided in its federally operated facilities has been limited and inconsistent. While some oversight functions are performed at the headquarters level, the agency has delegated primary responsibility for the oversight of care to nine area offices. Area officials stated that the oversight they provide has included, for example, hol...