Data collection (1 - 7 of 7 items) in Past Year
Medicaid: Program Oversight Hampered by Data Challenges, Underscoring Need for Continued Improvements
GAO-17-173: Published: Jan 6, 2017. Publicly Released: Feb 6, 2017.
GAO found that available Medicaid expenditure and utilization data do not provide CMS with sufficient information to consistently ensure that payments are proper or that beneficiaries have access to covered services. The Centers for Medicare & Medicaid Services (CMS), the agency within the Department of Health and Human Services (HHS) that administers the Medicaid program, relies on two key data s...
Indian Health Service: Actions Needed to Improve Oversight of Quality of Care
GAO-17-181: Published: Jan 9, 2017. Publicly Released: Jan 9, 2017.
The Indian Health Service's (IHS) oversight of the quality of care provided in its federally operated facilities has been limited and inconsistent. While some oversight functions are performed at the headquarters level, the agency has delegated primary responsibility for the oversight of care to nine area offices. Area officials stated that the oversight they provide has included, for example, hol...
Health Care Quality: HHS Should Set Priorities and Comprehensively Plan Its Efforts to Better Align Health Quality Measures
GAO-17-5: Published: Oct 13, 2016. Publicly Released: Oct 13, 2016.
While the full extent of misalignment among health care quality measures is unknown, it can have adverse effects on providers and efforts to improve quality of care. Misalignment occurs when health care payers require providers to report on measures that focus on different quality issues or define the measures using different specifications. GAO identified three studies that provided some informat...
Medicare Fee-For-Service: Opportunities Remain to Improve Appeals Process
GAO-16-366: Published: May 10, 2016. Publicly Released: Jun 9, 2016.
The appeals process for Medicare fee-for-service (FFS) claims consists of four administrative levels of review within the Department of Health and Human Services (HHS), and a fifth level in which appeals are reviewed by federal courts. Appeals are generally reviewed by each level sequentially, as appellants may appeal a decision to the next level depending on the prior outcome. Under the administr...
Medicaid Program Integrity: Improved Guidance Needed to Better Support Efforts to Screen Managed Care Providers
GAO-16-402: Published: Apr 22, 2016. Publicly Released: May 6, 2016.
GAO found that the selected states and Medicaid managed care plans face significant challenges in screening providers for eligibility to participate in the Medicaid program. Based on information we received from two selected states and 16 selected plans, GAO found that the states and plans used information that was fragmented across 22 databases managed by 15 different federal agencies to screen p...
Human Capital: Additional Actions Needed to Enhance DOD's Efforts to Address Mental Health Care Stigma
GAO-16-404: Published: Apr 18, 2016. Publicly Released: Apr 18, 2016.
Military servicemembers' perceive that a stigma exists with seeking mental health care, but little information is known about Department of Defense (DOD) deployed civilian perceptions. GAO's analysis of the most recently available data from a DOD-wide survey found that about 37 percent of active duty servicemembers in 2011 and 39 percent of reservists in the 2010/2011 timeframe responded that they...
National Institutes of Health: Additional Data Would Enhance the Stewardship of Clinical Trials across the Agency
GAO-16-304: Published: Mar 10, 2016. Publicly Released: Mar 10, 2016.
Although the National Institutes of Health (NIH) assessed the applicability of recommendations made by the Institute of Medicine (IOM) in 2010 to improve clinical trials—studies involving human subjects that test the effects of interventions on health-related outcomes—within one of its Institutes and Centers (IC), NIH did not apply the recommendations across its ICs. In response to a conferenc...