Medical expense claims (11 - 20 of 68 items)
Medicare Billing: Commercial System Could Save Hundreds of Millions Annually
AIMD-98-91: Published: Apr 15, 1998. Publicly Released: May 19, 1998.
Pursuant to a congressional request, GAO reviewed whether the Health Care Financing Administration (HCFA) used an adequate methodology for testing the commercial claims auditing system for potential nationwide implementation with its Medicare claims processing system.GAO noted that: (1) the test methodology HCFA used in Iowa was consistent with the approach used by other public health care insurer...
Medicare: Need to Overhaul Costly Payment System for Medical Equipment and Supplies
HEHS-98-102: Published: May 12, 1998. Publicly Released: May 15, 1998.
Pursuant to a congressional request, GAO reviewed Medicare's payments for commonly purchased, off-the-shelf durable medical equipment (DME), focusing on the need to: (1) better identify products billed to Medicare; and (2) bring Medicare fees more in line with current marketplace prices.GAO noted that: (1) there are two underlying problems with Medicare's DME payment system; (2) the Health Care Fi...
Medicare: Home Health Cost Growth and Administration's Proposal for Prospective Payment
T-HEHS-97-92: Published: Mar 5, 1997. Publicly Released: Mar 5, 1997.
GAO discussed Medicare's home health care benefit and the administration's forthcoming legislative proposals related to this Medicare benefit.GAO noted that: (1) Medicare's home health care costs have grown because a larger portion of beneficiaries use this benefit than in the past and the number of services used by each beneficiary has more than doubled; (2) a combination of factors led to the in...
Medicare: Early Resolution of Overcharges for Therapy in Nursing Homes Is Unlikely
HEHS-96-145: Published: Aug 16, 1996. Publicly Released: Sep 17, 1996.
Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) progress in curbing overbilling for occupational speech and physical therapy services.GAO found that: (1) therapy charges billed to Medicare by skilled nursing facilities (SNF) and rehabilitation agencies have more than doubled since 1990; (2) some providers are exploiting weaknesses in Medicare's p...
AARP Medigap Premium Increases, 1996
HEHS-96-119R: Published: Apr 19, 1996. Publicly Released: Apr 19, 1996.
Pursuant to a congressional request, GAO examined why Medigap premiums offered through the American Association of Retired Persons (AARP) were increasing. GAO noted that: (1) premiums for more than 3 million AARP Medigap policyholders increased an average of 26 percent; (2) the increases varied by state and ranged between 0 to 40 percent for both standardized and prestandardized policies; (3) in 1...
Medicare: Millions Can Be Saved by Screening Claims for Overused Services
T-HEHS-96-86: Published: Feb 8, 1996. Publicly Released: Feb 8, 1996.
GAO discussed how Medicare can avoid paying millions of dollars in claims for unnecessary services. GAO noted that: (1) the autoadjudicated prepayment screen is an inexpensive and compatible safeguard that is an effective and highly compatible claims processing system; (2) the 6 medical procedures reviewed are especially susceptible to overuse because few financial incentives exist for physicians...
Fraud and Abuse: Providers Target Medicare Patients in Nursing Facilities
HEHS-96-18: Published: Jan 24, 1996. Publicly Released: Feb 7, 1996.
Pursuant to a congressional request, GAO reviewed allegations of fraud and abuse related to services and supplies provided to nursing facility patients, focusing on: (1) the nature and extent of such fraud and abuse exist; (2) why nursing facility patients are an attractive target for miscreants; and (3) options for reducing fraudulent billing practices.GAO found that: (1) fraudulent and abusive b...
Fraud and Abuse: Medicare Continues to Be Vulnerable to Exploitation by Unscrupulous Providers
T-HEHS-96-7: Published: Nov 2, 1995. Publicly Released: Nov 2, 1995.
GAO discussed challenges Medicare faces in battling fraud and abuse in the health care system, focusing on reasons that: (1) Medicare is an appealing target for unscrupulous providers; and (2) abusive practices persist despite efforts by program managers and law enforcement agencies. GAO noted that: (1) although most Medicare providers abide by program rules, Medicare has difficulty preventing fra...
HCFA's Approach to Evaluating Medicare Technology
AIMD-95-234R: Published: Sep 29, 1995. Publicly Released: Sep 29, 1995.
Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) approach to analyzing the benefits of commercial technology in the Medicare program. GAO noted that HCFA: (1) is limiting its analysis of the benefits of commercial technology to determining whether Medicare contractors complied with existing payment controls and is using a flawed sampling methodolo...
Medicare: Excessive Payments for Medical Supplies Continue Despite Improvements
HEHS-95-171: Published: Aug 8, 1995. Publicly Released: Sep 13, 1995.
Pursuant to a congressional request, GAO reviewed Medicare payments for medical supplies, focusing on the: (1) circumstances surrounding payments for unusually high surgical dressing claims; and (2) adequacy of Medicare's internal controls to prevent paying such claims.GAO found that: (1) although the Health Care Financing Administration (HCFA) has eliminated medical suppliers' ability to select c...