Medicare (21 - 30 of 534 items)
Medicare Part B Drugs: Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals
GAO-15-442: Published: Jun 5, 2015. Publicly Released: Jul 6, 2015.
Certain providers, including hospitals that serve a disproportionate number of low-income patients, have access to discounted prices on outpatient drugs through the 340B Drug Pricing Program, which is administered by the Health Resources and Services Administration (HRSA) within the Department of Health & Human Services (HHS). In 2012, these hospitals—referred to as 340B disproportionate share h...
Medicaid: CMS Could Take Additional Actions to Help Improve Provider and Beneficiary Fraud Controls
GAO-15-665T: Published: Jun 2, 2015. Publicly Released: Jun 2, 2015.
GAO found thousands of Medicaid beneficiaries and hundreds of providers involved in potential improper or fraudulent payments during fiscal year 2011—the most-recent year for which reliable data were available in four selected states: Arizona, Florida, Michigan, and New Jersey. These states had about 9.2 million beneficiaries and accounted for 13 percent of all fiscal year 2011 Medicaid payments...
Medicaid: A Small Share of Enrollees Consistently Accounted for a Large Share of Expenditures
GAO-15-460: Published: May 8, 2015. Publicly Released: May 8, 2015.
A small percentage of Medicaid-only enrollees—that is, those who were not also eligible for Medicare—consistently accounted for a large percentage of total Medicaid expenditures for Medicaid-only enrollees. In each fiscal year from 2009 through 2011, the most expensive 5 percent of Medicaid-only enrollees accounted for almost half of the expenditures for all Medicaid-only enrollees. In contras...
Advance Directives: Information on Federal Oversight, Provider Implementation, and Prevalence
GAO-15-416: Published: Apr 29, 2015. Publicly Released: Apr 29, 2015.
The Centers for Medicare & Medicaid Services (CMS) oversees providers' implementation of the advance directive requirement in the Patient Self Determination Act (PSDA) to maintain written policies and procedures to inform individuals about advance directives, and document information about individuals' advance directives in the medical record by providing guidance and monitoring covered providers...
Medicare: Potential Uses of Electronically Readable Cards for Beneficiaries and Providers
GAO-15-319: Published: Mar 25, 2015. Publicly Released: Apr 24, 2015.
The Centers for Medicare & Medicaid Services (CMS)—the agency that administers Medicare—could use electronically readable cards in Medicare for a number of different purposes. Three key uses include authenticating beneficiary and provider presence at the point of care, electronically exchanging beneficiary medical information, and electronically conveying beneficiary identity and insurance inf...
Sole Community Hospitals: Early Indications Show That TRICARE's Revised Reimbursement Rules Have Not Affected Access to Care
GAO-15-402: Published: Apr 15, 2015. Publicly Released: Apr 15, 2015.
TRICARE's revised reimbursement rules for Sole Community Hospitals (SCHs), which provide health care in rural areas or where similar hospitals do not exist under certain criteria, approximate those for Medicare's. Specifically, both programs reimburse SCHs using the greater of either a cost-based amount or the allowed amount under a diagnostic-related-group-based payment system, although each prog...
Improper Payments: TRICARE Measurement and Reduction Efforts Could Benefit from Adopting Medical Record Reviews
GAO-15-269: Published: Feb 18, 2015. Publicly Released: Feb 18, 2015.
The Defense Health Agency (DHA), the agency within the Department of Defense (DOD) responsible for administering the military health program known as TRICARE, uses a methodology for measuring TRICARE improper payments that is less comprehensive than the methodology used to measure improper payments in Medicare, the federal health care program for the elderly and certain disabled individuals. Both...
International Classification of Diseases: CMS's Efforts to Prepare for the New Version of the Disease and Procedure Codes
GAO-15-255: Published: Jan 28, 2015. Publicly Released: Feb 6, 2015.
The Centers for Medicare & Medicaid Services (CMS), within the Department of Health and Human Services (HHS), has undertaken a number of efforts to prepare for the October 1, 2015, transition to the 10th revision of the International Classification of Diseases (ICD-10) codes, which are used for documenting patient medical diagnoses and inpatient medical procedures. CMS has developed educational ma...
Medicare: Bidding Results from CMS's Durable Medical Equipment Competitive Bidding Program
GAO-15-63: Published: Nov 7, 2014. Publicly Released: Dec 8, 2014.
The Medicare competitive bidding program (CBP) for durable medical equipment (DME) is administered by the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS). Under the CBP, only competitively selected contract suppliers can furnish certain DME items (such as oxygen supplies and hospital beds) at competitively determined prices to Medicare benefi...
Medicare Program Integrity: CMS Pursues Many Practices to Address Prescription Drug Fraud, Waste, and Abuse
GAO-15-66: Published: Oct 24, 2014. Publicly Released: Nov 24, 2014.
GAO identified 23 practices for addressing prescription drug fraud, waste, and abuse that fall within three categories based on GAO's Fraud Prevention Framework—prevention, detection and monitoring, and investigation and prosecution.The Department of Health and Human Services' (HHS) Centers for Medicare & Medicaid Services' (CMS) activities to address prescription drug fraud, waste, and abuse in...