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Health Care (111 - 120 of 4,924 items)
Health Care Fraud: Information on Most Common Schemes and the Likely Effect of Smart Cards
GAO-16-216: Published: Jan 22, 2016. Publicly Released: Feb 22, 2016.
GAO's review of 739 health care fraud cases that were resolved in 2010 showed the following:About 68 percent of the cases included more than one scheme with 61 percent including two to four schemes and 7 percent including five or more schemes.The most common health care fraud schemes were related to fraudulent billing, such as billing for services that were not provided (about 43 percent of cases)...
Unaccompanied Children: HHS Can Take Further Actions to Monitor Their Care
GAO-16-180: Published: Feb 5, 2016. Publicly Released: Feb 22, 2016.
In fiscal year 2014, nearly 57,500 children traveling without their parents or guardians (referred to as unaccompanied children) were apprehended by federal immigration officers and transferred to the care of the Department of Health and Human Services' Office of Refugee Resettlement (ORR). Most of these children were from Central America. GAO found that ORR was initially unprepared to care for th...
Medicaid: Efforts to Exclude Nonemergency Transportation Not Widespread, but Raise Issues for Expanded Coverage
GAO-16-221: Published: Jan 15, 2016. Publicly Released: Feb 16, 2016.
States' efforts to exclude nonemergency medical transportation (NEMT) benefits from enrollees who are newly eligible for Medicaid under the Patient Protection and Affordable Care Act (PPACA) are not widespread. Of the 30 states that expanded Medicaid as of September 30, 2015, 25 reported that they did not undertake efforts to exclude the NEMT benefit for newly eligible enrollees, 3 states reported...
Veterans' Health Care: Preliminary Observations on VHA's Claims Processing Delays and Efforts to Improve the Timeliness of Payments to Community Providers
GAO-16-380T: Published: Feb 11, 2016. Publicly Released: Feb 11, 2016.
To help ensure that veterans are provided timely and accessible health care services, the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) has purchased care from non-VA community providers through its care in the community programs since as early as 1945. GAO's preliminary work from the sites it visited shows that in fiscal year 2015, VHA's claims processing was sig...
Medicaid: Changes to Funding Formula Could Improve Allocation of Funds to States
GAO-16-377T: Published: Feb 10, 2016. Publicly Released: Feb 10, 2016.
In prior work, GAO identified alternative measures that could be used to allocate Medicaid funding to states more equitably than the current Federal Medical Assistance Percentage (FMAP) formula, which uses per capita income (PCI) to calculate each state's federal matching rate. GAO found that PCI is a poor proxy for both the size of a state's population in need of Medicaid services and the ability...
Medicaid Managed Care: Trends in Federal Spending and State Oversight of Costs and Enrollment
GAO-16-77: Published: Dec 17, 2015. Publicly Released: Jan 19, 2016.
Federal spending for Medicaid managed care increased significantly from fiscal year 2004 through fiscal year 2014 (from $27 billion to $107 billion), and represented 38 percent of total federal Medicaid spending in fiscal year 2014. Consistent with this national trend, managed care as a proportion of total federal Medicaid spending was higher in seven of eight selected states in fiscal year 2014 c...
Medicare and Medicaid: Additional Oversight Needed of CMS's Demonstration to Coordinate the Care of Dual-Eligible Beneficiaries
GAO-16-31: Published: Dec 18, 2015. Publicly Released: Jan 19, 2016.
Due to the flexibility that states have in designing their Financial Alignment Demonstrations, the integrated care organizations that GAO interviewed in California, Illinois, Massachusetts, Virginia, and Washington implemented care coordination for dual-eligible Medicare and Medicaid beneficiaries in a variety of ways. For example, these organizations assigned care coordinators to beneficiaries us...
Drug Safety: FDA Expedites Many Applications, But Data for Postapproval Oversight Need Improvement
GAO-16-192: Published: Dec 15, 2015. Publicly Released: Jan 14, 2016.
From October 1, 2006, to December 31, 2014, the Food and Drug Administration's (FDA) Center for Drug Evaluation and Research (CDER) received about 1,000 requests for fast track designation and breakthrough therapy designation—two of the agency's four expedited programs to facilitate and expedite the development and review of new drugs. Drug sponsors are required to submit formal requests to use...
Health Care Workforce: Comprehensive Planning by HHS Needed to Meet National Needs
GAO-16-17: Published: Dec 11, 2015. Publicly Released: Jan 11, 2016.
The Department of Health and Human Services (HHS) engages in some planning for the 72 health care workforce programs administered by its agencies, but lacks comprehensive planning and oversight to ensure that these efforts meet national health care workforce needs. HHS's current strategic plan includes broad strategies—such as improving access to comprehensive primary and preventive medical serv...
Drug Compounding for Animals: FDA Could Improve Oversight with Better Information and Guidance [Reissued on January 8, 2016]
GAO-15-671: Published: Sep 28, 2015. Publicly Released: Sep 28, 2015.
Drugs compounded for animals offer certain medical benefits but also pose risks of causing harm or being ineffective. Specifically, drugs compounded for animals can serve as treatment options when no suitable drug approved by the Food and Drug Administration (FDA) is available. For example, no FDA-approved drugs exist to treat megacolon—a potentially lethal form of constipation—in cats, so vet...