Beneficiaries (91 - 100 of 438 items)
Prescription Drug Data: HHS Has Issued Health Privacy and Security Regulations but Needs to Improve Guidance and Oversight
GAO-12-605: Published: Jun 22, 2012. Publicly Released: Jun 22, 2012.
While the Department of Health and Human Services (HHS) has established a framework for protecting the privacy and security of Medicare beneficiaries prescription drug use information when used for purposes other than direct clinical care through its issuance of regulations, outreach, and enforcement activities, it has not issued all required guidance or fully implemented required oversight...
Medicaid: States' Plans to Pursue New and Revised Options for Home- and Community-Based Services
GAO-12-649: Published: Jun 13, 2012. Publicly Released: Jun 21, 2012.
The four Medicaid options for home- and community-based services (HCBS) included in the Patient Protection and Affordable Care Act (PPACA) provide states with new incentives and flexibilities to help increase the availability of services for Medicaid beneficiaries. Two of the options were newly created by PPACA, and the other two were existing options amended by the law. Three of the options provi...
Medicare: Trends in Beneficiaries Served and Hospital Resources Used in Implantable Medical Device Procedures
GAO-12-583R: Published: May 14, 2012. Publicly Released: Jun 13, 2012.
Overall, orthopedic IMD admission rates were substantially higher in 2009 compared with 2003, while admission rate patterns among cardiac IMDs were mixed. Admission rates rose for each of the orthopedic IMDs in our study, with knee replacement rates growing 6.7 percent per year. The picture for inpatient cardiac IMD procedures was more mixed; admission rates for dual-chamber pacemakers decreased s...
Program Integrity: Further Action Needed to Address Vulnerabilities in Medicaid and Medicare Programs
GAO-12-803T: Published: Jun 7, 2012. Publicly Released: Jun 7, 2012.
For the Medicaid program, the Centers for Medicare & Medicaid Services (CMS) and the states have taken some actions related to GAOs four key strategies but more needs to be done.CMSs comprehensive state program integrity reviews identified provider enrollment as the most frequently cited area of concern but the agency has noted a positive trend in states awareness of regulatory r...
Department of Health and Human Services: Opportunities for Financial Savings and Program Improvements in Medicare and Medicaid Remain
GAO-12-719T: Published: May 9, 2012. Publicly Released: May 9, 2012.
Over the past several years, GAO has made a number of recommendations to the Centers for Medicare & Medicaid Services (CMS)an agency within the Department of Health and Human Services (HHS)to increase savings in Medicare fee-for-service and Medicare Advantage (MA), which is a private plan alternative to the traditional Medicare fee-for-service program. Open recommendations that could y...
Medicare: Review of the First Year of CMS's Durable Medical Equipment Competitive Bidding Program's Round 1 Rebid
GAO-12-693: Published: May 9, 2012. Publicly Released: May 9, 2012.
The Centers for Medicare and Medicaid Services (CMS), within the Department of Health and Human Services (HHS), implemented the durable medical equipment (DME) competitive bidding programs (CBP) bidding process for the round 1 rebid. Nearly the same number of suppliers submitted a similar number of bids for both the CBP round 1 rebid and round 1. Many suppliers continued to have difficulty c...
Medicare: The First Year of the Durable Medical Equipment Competitive Bidding Program Round 1 Rebid
GAO-12-733T: Published: May 9, 2012. Publicly Released: May 9, 2012.
Our work on the outcomes of the CBP round 1 rebid found that the number of bidding suppliers and the number of contracts awarded in the CBP round 1 rebid were very similar to the CBP round 1 and about a third of the 1,011 suppliers that bid in the rebid were awarded at least one CBP contract. CMS made improvements to the bidding process for the CBP round 1 rebidsuch as providing additional i...
Medicare Advantage: Quality Bonus Payment Demonstration Undermined by High Estimated Costs and Design Shortcomings
GAO-12-409R: Published: Mar 21, 2012. Publicly Released: Apr 23, 2012.
In summary, we found the following:OACT has estimated that the MA Quality Bonus Payment Demonstration will cost $8.35 billion over 10 years, most of which will be paid to 3-star and 3.5-star plans. About $5.34 billion of OACTs cost estimate is attributed to quality bonus payments more generous than those prescribed in PPACA, specifically to (1) higher bonuses for 4-star and 5-star plans, (2)...
Medicare Program Integrity: CMS Continues Efforts to Strengthen the Screening of Providers and Suppliers
GAO-12-351: Published: Apr 10, 2012. Publicly Released: Apr 23, 2012.
Medicare claims are screened against enrollment information, using automated enrollment-related prepayment edits, in an effort to prevent improper payments to ineligible providers and supplierssuch as those that are no longer active in the Medicare program or are not properly licensed to provide the services for which they have submitted claims. Officials with the contractors we interviewed...
Federal Antitrust Policy: Stakeholders' Perspectives Differed on the Adequacy of Guidance for Collaboration among Health Care Providers
GAO-12-291R: Published: Mar 16, 2012. Publicly Released: Apr 16, 2012.
Stakeholdershealth care industry groups and experts in antitrust lawhad different perspectives on the adequacy of three key aspects of antitrust guidance for health care provider collaboration. First, stakeholders perspectives differed on the sufficiency of guidance on clinical integration, which involves integrating clinical activities across providers in a collaborative arrange...