Medical services rates (41 - 50 of 79 items)
Medicare Spending: Modern Management Strategies Needed to Curb Billions in Unnecessary Payments
HEHS-95-210: Published: Sep 19, 1995. Publicly Released: Sep 19, 1995.
Pursuant to a congressional request, GAO examined Medicare's vulnerability to provider exploitation and ways to remedy Medicare fraud and abuse.GAO found that Medicare is vulnerable to billions of dollars in unnecessary payments, since Medicare: (1) pays higher than market rates for certain services and supplies; (2) anti-fraud and abuse controls do not systematically prevent the payment of claims...
Preventing Abusive Medicare Billing
HEHS-95-260R: Published: Sep 5, 1995. Publicly Released: Sep 5, 1995.
Pursuant to a congressional request, GAO discussed its recommendations for preventing abusive Medicare billing and whether the recommendations can be implemented legislatively. GAO noted that: (1) Medicare law could be amended to require the Department of Health and Human Services (HHS) to establish the requirements recommended, as well as establish a higher limit on the amount that Medicare will...
Medicare Managed Care: Enrollment Growth Underscores Need to Revamp HMO Payment Methods
T-HEHS-95-207: Published: Jul 12, 1995. Publicly Released: Jul 12, 1995.
Pursuant to a congressional request, GAO discussed the: (1) recent trends in Medicare beneficiary enrollment in health maintenance organizations (HMO); (2) obstacles that are preventing Medicare from realizing potential savings from HMO; (3) strategies that will enable Medicare to realize HMO savings; and (4) Health Care Financing Administration's (HCFA) efforts to test HMO payment reforms. GAO no...
Medicare: Rapid Spending Growth Calls for More Prudent Purchasing
T-HEHS-95-193: Published: Jun 28, 1995. Publicly Released: Jun 28, 1995.
GAO discussed ways in which the Medicare program could avoid excessive or unnecessary spending. GAO noted that: (1) although private payers increasingly use aggressive cost-management strategies to control health care costs, the Health Care Financing Administration (HCFA) often finds it difficult to use these strategies to control health care costs, since payment policies are established at the co...
Medicare Hospital Payments
HEHS-95-158R: Published: May 25, 1995. Publicly Released: May 25, 1995.
Pursuant to a congressional request, GAO provided information on the growth in Medicare hospital payments, focusing on the annual payment growth rates for various types of hospitals. GAO noted that: (1) while general inflation grew about 3.5 percent annually from 1984 through 1992, hospital payments per discharge grew at an annual rate of 5.4 percent; (2) major teaching hospitals averaged a 5.7 pe...
Medicare: Tighter Rules Needed to Curtail Overcharges for Therapy in Nursing Homes
HEHS-95-23: Published: Mar 30, 1995. Publicly Released: Apr 19, 1995.
Pursuant to a congressional request, GAO reviewed billings for inappropriate or undelivered therapy services, focusing on overcharges to Medicare nursing home patients.GAO found that: (1) the providers responsible for overcharges for therapy services are often rehabilitation companies or nursing homes; (2) the problem of overcharging is national in scope and growing in magnitude; (3) markups on th...
Medicare: Changes to HMO Rate Setting Method Are Needed to Reduce Program Costs
HEHS-94-119: Published: Sep 2, 1994. Publicly Released: Sep 2, 1994.
Pursuant to a legislative requirement, GAO reviewed: (1) Medicare's rate setting methodology for health maintenance organizations (HMO); and (2) the ability of the Medicare risk contract program to achieve cost savings.GAO found that: (1) the Medicare risk contract program has not reduced Medicare costs because the Health Care Financing Administration's (HCFA) rate setting methodology and administ...
Medicare: Graduate Medical Education Payment Policy Needs to Be Reexamined
HEHS-94-33: Published: May 4, 1994. Publicly Released: May 12, 1994.
Pursuant to a congressional request, GAO reviewed Medicare financing for graduate medical education (GME), focusing on: (1) how Medicare compensates hospitals for GME costs; and (2) the extent of Medicare's support for primary care and nonprimary care physicians' GME.GAO found that: (1) Medicare pays for about 29 percent of total GME direct costs, which totalled $1.46 billion in 1992; (2) although...
Medicare: Impact of OBRA-90's Dialysis Provisions on Providers and Beneficiaries
HEHS-94-65: Published: Apr 25, 1994. Publicly Released: Apr 25, 1994.
Pursuant to a legislative requirement, GAO provided information on how Medicare End-Stage Renal Disease Program (ESRD) patients are affected by provisions requiring employer-sponsored health care plans to pay for dialysis before Medicare does, focusing on the: (1) amount of money dialysis providers receive; and (2) out-of-pocket payments that Medicare beneficiaries make.GAO found that: (1) dialysi...
Managed Health Care: Effect on Employers' Costs Difficult to Measure
HRD-94-3: Published: Oct 19, 1993. Publicly Released: Oct 19, 1993.
Pursuant to a congressional request, GAO reviewed employers' recent experiences with managed health care, focusing on cost control and enrollee perspectives.GAO found that: (1) the proportion of private-sector employees enrolled in managed care plans increased from 5 percent in 1980 to 55 percent in 1992; (2) managed care cost control efforts involve alternative financing methods and limitations o...