Medicare (81 - 90 of 286 items)
Retired Coal Miners' Health Benefit Funds: Financial Challenges Continue
GAO-02-243: Published: Apr 18, 2002. Publicly Released: May 20, 2002.
More than 100,000 retired coal miners and their spouses and dependents in 1992 faced a potential decrease in their employment-related health insurance coverage or loss of such coverage altogether. Some former employers had stopped mining coal or gone out of business and were no longer contributing to the United Mine Workers of America (UMWA) retiree benefit funds. To ensure that these individuals...
Medicare Home Health Care: Payments to Home Health Agencies Are Considerably Higher than Costs
GAO-02-663: Published: May 6, 2002. Publicly Released: May 6, 2002.
The Balanced Budget Act of 1997 significantly changed Medicare's home health care payments to home health agencies (HHAs). Under a prospective payment system (PPS), HHAs are paid a fixed amount, adjusted for beneficiary care needs, for providing up to 60 days of care---termed a "home health episode." The act also imposed new interim payment limits to moderate spending until the PPS could be imple...
Medicare Home Health: Clarifying the Homebound Definition Is Likely to Have Little Effect on Costs and Access
GAO-02-555R: Published: Apr 26, 2002. Publicly Released: Apr 26, 2002.
Medicare's home health benefit provides skilled nursing and other services to beneficiaries who are homebound. The Department of Health and Human Services (HHS) had a long-standing policy that beneficiaries who regularly attend adult day care were not considered homebound, particularly if the purpose of attending was to receive nonmedical or custodial care. In 2000, Congress indicated that Medicar...
Medicare Fraud and Abuse: DOJ Continues to Promote Compliance with False Claims Act Guidance
GAO-02-546: Published: Apr 5, 2002. Publicly Released: Apr 5, 2002.
The Department of Justice (DOJ) recovered more than $1.2 billion in health care fraud cases in fiscal year 2001. The False Claims Act bolstered DOJ's recoveries and enabled the government to seek damages and penalties against providers who knowingly submitted fraudulent bills to Medicare, Medicaid, or other government programs. In the late 1990s, industry representatives voiced concerns that DOJ...
Medicare Subvention Demonstration: Pilot Satisfies Enrollees, Raises Cost and Management Issues for DOD Health Care
GAO-02-284: Published: Feb 11, 2002. Publicly Released: Feb 11, 2002.
The Department of Defense's (DOD) Medicare subvention demonstration tested alternate approaches to health care coverage for military retirees. Retirees could enroll in new DOD-run Medicare managed care plans, known as TRICARE Senior Prime, at six sites. The demonstration plan offered enrollees the full range of Medicare-covered services as well as additional TRICARE services, with minimal copaymen...
Ambulance Services: Changes Needed to Improve Medicare Payment Policies and Coverage Decisions
GAO-02-244T: Published: Nov 15, 2001. Publicly Released: Nov 15, 2001.
The Balanced Budget Act of 1997 required Medicare to change its payment system for ambulance services. In response, the Health Care Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), proposed a fee schedule to standardize payments across provider types on the basis of national rates for particular services. Under the act, the fee schedule was to have...
Medicare Physician Fee Schedule: Practice Expense Payments to Oncologists Indicate Need For Overall Refinements
GAO-02-53: Published: Oct 31, 2001. Publicly Released: Oct 31, 2001.
Medicare's physician fee schedule establishes payments for more than 7,000 different services, such as office visits, surgical procedures, and treatments. Before 1992, fees were based on charges physicians billed for these services. Since then, the Health Care Financing Administration (HCFA), which runs Medicare, has been phasing in a new fee schedule on the basis of the amount of resources used t...
Medicare Subvention Demonstration: DOD Costs and Medicare Spending
GAO-02-67: Published: Oct 31, 2001. Publicly Released: Oct 31, 2001.
The Balanced Budget Act of 1997 authorized the Department of Defense (DOD) to conduct the Medicare subvention demonstration for a three-year period. Under this demonstration, DOD formed Medicare managed care organizations--collectively called TRICARE Senior Prime--at six sites that provided the full range of Medicare-covered services as well as additional DOD-covered services, notably prescription...
Medicare Subvention Demonstration: Greater Access Improved Enrollee Satisfaction but Raised DOD Costs
GAO-02-68: Published: Oct 31, 2001. Publicly Released: Oct 31, 2001.
In the Balanced Budget Act of 1997, Congress established a three-year demonstration, called Medicare subvention, to improve the access of Medicare-eligible military retirees to care at military treatment facilities (MTF). The demonstration allowed Medicare-eligible retirees to get their health care largely at MTFs by enrolling in a Department of Defense (DOD) Medicare managed care organization kno...
Medicare+Choice Audits: Lack of Audit Follow-up Limits Usefulness
GAO-02-33: Published: Oct 9, 2001. Publicly Released: Oct 9, 2001.
The Centers for Medicare and Medicaid Services (CMS) spent about $35 billion in 2000 on the Medicare+Choice program--the managed care alternative to Medicare's fee-for-service program. During that time, almost 6.3 million Medicare beneficiaries were enrolled in health plans offered by managed care organizations (MCO) that participate in the Medicare+Choice program. Each year, any MCO choosing to...