Medicaid (111 - 120 of 1,026 items)
Medicaid: Data Sets Provide Inconsistent Picture of Expenditures
GAO-13-47: Published: Oct 29, 2012. Publicly Released: Nov 29, 2012.
Medicaid expenditures in the Medicaid Statistical Information System (MSIS) were generally less than CMS-64 amounts. National expenditures in MSIS were 86, 87, and 88 percent of the amounts in CMS-64 in fiscal years 2007 through 2009, respectively. In fiscal year 2009, MSIS expenditures for states ranged from 59 to 119 percent of CMS-64. Specifically, 40 states reported lower expenditures in MSIS...
Health Care Fraud: Types of Providers Involved in Medicare Cases, and CMS Efforts to Reduce Fraud
GAO-13-213T: Published: Nov 28, 2012. Publicly Released: Nov 28, 2012.
In recently completed work, we found that medical facilities (such as medical centers, clinics, and practices) and durable medical equipment suppliers were the most frequent subjects of criminal fraud cases in Medicare, Medicaid, and CHIP in 2010. Hospitals and medical facilities were the most frequent subjects of civil fraud cases, including cases that resulted in judgments or settlements. Accord...
Medicaid: States Made Multiple Program Changes, and Beneficiaries Generally Reported Access Comparable to Private Insurance
GAO-13-55: Published: Nov 15, 2012. Publicly Released: Nov 15, 2012.
From 2008 to 2011, more than half of states reported maintaining or decreasing their average Medicaid application processing times--the average number of calendar days between the receipt of a new application and the final determination of eligibility. The average processing times reported by 39 states ranged from 11 to 45 calendar days. For the same time period, however, GAO was unable to assess...
Medicare Fraud Prevention: CMS Has Implemented a Predictive Analytics System, but Needs to Define Measures to Determine Its Effectiveness
GAO-13-104: Published: Oct 15, 2012. Publicly Released: Nov 15, 2012.
The Centers for Medicare and Medicaid Services (CMS) implemented its Fraud Prevention System (FPS) in July 2011, as required by the Small Business Jobs Act, and the system is being used by CMS and its program integrity contractors who conduct investigations of potentially fraudulent claims. Specifically, FPS analyzes Medicare claims data using models of fraudulent behavior, which results in automa...
Health Care Fraud: Types of Providers Involved in Medicare, Medicaid, and the Children's Health Insurance Program Cases
GAO-12-820: Published: Sep 7, 2012. Publicly Released: Oct 9, 2012.
According to 2010 data from the Department of Health and Human Services' Office of the Inspector General (HHS-OIG) and the Department of Justice (DOJ), 10,187 subjects--individuals and entities involved in fraud cases--were investigated for health care fraud, including fraud in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). These subjects included different types of provid...
Medicare Special Needs Plans: CMS Should Improve Information Available about Dual-Eligible Plans' Performance
GAO-12-864: Published: Sep 13, 2012. Publicly Released: Sep 19, 2012.
Why GAO Did This StudyAbout 9 million of Medicare's over 48 million beneficiaries are also eligible for Medicaid because they meet income and other criteria. These dual-eligible beneficiaries have greater health care challenges than other Medicare beneficiaries, increasing their need for care coordination across the two programs. In addition to meeting all the requirements of other MA plans, D-SNP...
Medicaid: States' Use of Managed Care
GAO-12-872R: Published: Aug 17, 2012. Publicly Released: Sep 17, 2012.
In summary, we identified four groups of states that differed in their use of Medicaid managed care on the basis of the 12 indicators we included in our analysis. A handful of these indicatorsnamely Medicaid enrollment in MCOs and PCCM programs, HMO penetration rates, and the concentration of low-income individuals that lived in urban areashad significant influence on how states groupe...
Medicare Savings Programs: Implementation of Requirements Aimed at Increasing Enrollment
GAO-12-871: Published: Sep 14, 2012. Publicly Released: Sep 14, 2012.
The Social Security Administration (SSA) took a number of steps to implement the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requirements aimed at eliminating barriers to Medicare Savings Program (MSP) enrollment and spent about $12 million in fiscal years 2009 through 2011 to do so. SSA reported transferring over 1.9 million Low-Income Subsidy (LIS) program applications t...
Medicaid Long-Term Care: Information Obtained by States about Applicants' Assets Varies and May Be Insufficient
GAO-12-749: Published: Jul 26, 2012. Publicly Released: Aug 27, 2012.
States reported requiring applicants to provide documentation for most of the 13 types of assets included in GAOs survey.States varied in the extent to which they obtained information from third parties to verify applicants assets. For example, all states conducted data matches with the Social Security Administration but used other sources to a lesser extent. While states impleme...
Medicaid: States Reported Billions More in Supplemental Payments in Recent Years
GAO-12-694: Published: Jul 20, 2012. Publicly Released: Aug 20, 2012.
States reported $32 billion in Medicaid supplemental payments during fiscal year 2010, but the exact amount of supplemental payments is unknown because state reporting was incomplete. On expenditure reports used to obtain federal funds filed with the Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS), states reported the following:A total of $17.6 bi...