Health care programs (61 - 70 of 363 items)
Medicare Part D: Instances of Questionable Access to Prescription Drugs
GAO-11-699: Published: Sep 6, 2011. Publicly Released: Oct 4, 2011.
In 2009, GAO reported on doctor shopping in Medicaid, where individuals see several doctors and pharmacies, receiving more of a drug than was intended by any single physician. Questions have been raised about whether similar activity exists in Medicare Part D. GAO was asked to (1) determine the extent to which Medicare beneficiaries obtained frequently abused drugs from multiple prescribers, (2) i...
Drug Pricing: Manufacturer Discounts in the 340B Program Offer Benefits, but Federal Oversight Needs Improvement
GAO-11-836: Published: Sep 23, 2011. Publicly Released: Sep 23, 2011.
The Health Resources and Services Administration (HRSA), within in the Department of Health and Human Services (HHS), oversees the 340B Drug Pricing Program, through which participating drug manufacturers give certain entities within the health care safety net--known as covered entities--access to discounted prices on outpatient drugs. Covered entities include specified federal grantees and hospit...
Medicaid and CHIP: Most Physicians Serve Covered Children but Have Difficulty Referring Them for Specialty Care
GAO-11-624: Published: Jun 30, 2011. Publicly Released: Jun 30, 2011.
Medicaid and the Children's Health Insurance Program (CHIP)--two joint federal-state health care programs for certain low-income individuals--play a critical role in addressing the health care needs of children. The Children's Health Insurance Program Reauthorization Act of 2009 required GAO to study children's access to care under Medicaid and CHIP, including information on physicians' willingnes...
Health Care Fraud and Abuse Control Program: Improvements Needed in Controls over Reporting Deposits and Expenditures
GAO-11-446: Published: May 10, 2011. Publicly Released: Jun 9, 2011.
To help combat fraud and abuse in health care programs, including Medicare and Medicaid, Congress enacted the Health Care Fraud and Abuse Control (HCFAC) program as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA requires that the Departments of Health and Human Services (HHS) and Justice (DOJ) issue a joint annual report to Congress on amounts deposited to a...
Medicaid and CHIP: Reports for Monitoring Children's Health Care Services Need Improvement
GAO-11-293R: Published: Apr 5, 2011. Publicly Released: Apr 5, 2011.
Medicaid and the Children's Health Insurance Program (CHIP)--two joint federal-state health care programs for low-income families and children--play a critical role in addressing the health care needs of children. In 2008, more than 36 million children in the United States received health care coverage through Medicaid or CHIP. Like all children, children covered by Medicaid and CHIP may have heal...
Medicare and Medicaid Fraud, Waste, and Abuse: Effective Implementation of Recent Laws and Agency Actions Could Help Reduce Improper Payments
GAO-11-409T: Published: Mar 9, 2011. Publicly Released: Mar 9, 2011.
GAO has designated Medicare and Medicaid as high-risk programs because they are particularly vulnerable to fraud, waste, abuse, and improper payments (payments that should not have been made or were made in an incorrect amount). Medicare is considered high-risk in part because of its complexity and susceptibility to improper payments, and Medicaid because of concerns about the adequacy of its fisc...
Medicaid and CHIP: Given the Association between Parent and Child Insurance Status, New Expansions May Benefit Families
GAO-11-264: Published: Feb 4, 2011. Publicly Released: Feb 4, 2011.
The 2010 Patient Protection and Affordable Care Act (PPACA) expands health insurance to millions of individuals, including many parents. New insurance options for parents raise a question about whether providing health insurance to parents benefits their children. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) asked GAO to assess (1) the extent a parent's health insur...
Oral Health: Efforts Under Way to Improve Children's Access to Dental Services, but Sustained Attention Needed to Address Ongoing Concerns
GAO-11-96: Published: Nov 30, 2010. Publicly Released: Nov 30, 2010.
The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) required GAO to study children's access to dental care. GAO assessed (1) the extent to which dentists participate in Medicaid and the Children's Health Insurance Program (CHIP) and federal efforts to help families find participating dentists; (2) data on access for Medicaid and CHIP children in different states and in man...
School-Based Health Centers: Available Information on Federal Funding
GAO-11-18R: Published: Oct 8, 2010. Publicly Released: Oct 8, 2010.
Many of our nation's children have difficulty accessing needed health care services. In 2008, the Robert Wood Johnson Foundation reported that about 25 percent of children with insurance and about 55 percent of uninsured children did not receive a recommended routine checkup within the previous year. According to the Department of Health and Human Services (HHS), children face growing risks from c...
Medicaid Managed Care: CMS's Oversight of States' Rate Setting Needs Improvement
GAO-10-810: Published: Aug 4, 2010. Publicly Released: Aug 4, 2010.
Medicaid managed care rates are required to be actuarially sound. A state is required to submit its rate-setting methodology, including a description of the data used, to the Department of Health and Human Services' (HHS) Centers for Medicare & Medicaid Services (CMS) for approval. The Children's Health Insurance Program Reauthorization Act of 2009 required GAO to examine the extent to which state...