Eligibility determinations (1 - 3 of 3 items) in Past Year
Medicare: Initial Results of Revised Process to Screen Providers and Suppliers, and Need for Objectives and Performance Measures
GAO-17-42: Published: Nov 15, 2016. Publicly Released: Dec 15, 2016.
GAO's analysis of the Centers for Medicare & Medicaid Services' (CMS) Medicare enrollment data found that CMS used its revised enrollment screening process to screen and revalidate over 2.4 million unique new applications and existing enrollment records. GAO's analysis showed that the screening resulted in over 23,000 new applications being denied or rejected and over 703,000 existing enrollment r...
Medicare: Opportunities Exist to Recover Potential Overpayments to Providers with Criminal Backgrounds
GAO-16-365R: Published: Apr 13, 2016. Publicly Released: Apr 13, 2016.
Opportunities exist for the Centers for Medicare & Medicaid Services (CMS) to recover about $1.3 million in potential overpayments to 16 out of 66 potentially ineligible providers with criminal backgrounds who were enrolled in Medicare before CMS implemented more extensive background-check processes in April 2014. These 16 providers had Medicare claims paid to them while they were potentially inel...
Patient Protection and Affordable Care Act: CMS Should Act to Strengthen Enrollment Controls and Manage Fraud Risk
GAO-16-506T: Published: Mar 17, 2016. Publicly Released: Mar 17, 2016.
The Patient Protection and Affordable Care Act (PPACA) requires applicant information be verified to determine eligibility for enrollment or income-based subsidies. To implement this verification process, the Centers for Medicare & Medicaid Services (CMS) created an electronic system called the “data services hub” (data hub), which, among other things, provides a single link to federal sources...