Health care services (1 - 10 of 353 items)
Private Health Insurance: In Most States and New Exchanges, Enrollees Continued to be Concentrated among Few Issuers in 2014 [Reissued on February 14, 2017]
GAO-16-724: Published: Sep 6, 2016. Publicly Released: Sep 6, 2016.
GAO found that enrollment in private health insurance plans remained concentrated among a small number of issuers in most states in 2014, including in the newly established exchanges. On average in each state and the District of Columbia, 11 or more issuers participated in each of three types of markets—individual, small group, and large group—from 2011 through 2014. However, in most states, t...
Medicare Value-Based Payment Models: Participation Challenges and Available Assistance for Small and Rural Practices
GAO-17-55: Published: Dec 9, 2016. Publicly Released: Dec 9, 2016.
Based on a review of literature and interviews with 38 stakeholders, GAO identified challenges faced by small and rural physician practices when participating in Medicare's new payment models. These models, known as value-based payment models, are intended to reward health care providers for resource use and quality, rather than volume, of services. The challenges identified are in five key topic...
Hospital Uncompensated Care: Federal Action Needed to Better Align Payments with Costs
GAO-16-568: Published: Jun 30, 2016. Publicly Released: Aug 1, 2016.
Key sources of federal support for hospitals incurring costs for services provided to uninsured and other low-income individuals (uncompensated care costs) include multiple types of Medicaid and Medicare payments totaling about $50 billion annually. GAO's analysis shows that through Medicaid, a joint federal-state program for low-income individuals, states made three types of payments that helped...
Medicare Advantage: Action Needed to Ensure Appropriate Payments for Veterans and Nonveterans
GAO-16-137: Published: Apr 11, 2016. Publicly Released: May 11, 2016.
In fiscal year 2010, the Department of Veterans Affairs (VA) health care system provided $2.4 billion in inpatient and outpatient services to the 833,684 veterans enrolled in Medicare Advantage (MA), a private plan alternative to Medicare fee-for-service (FFS). While the Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), generally pa...
Veterans' Health Care: Proper Plan Needed to Modernize System for Paying Community Providers
GAO-16-353: Published: May 11, 2016. Publicly Released: May 11, 2016.
To help ensure that veterans are provided timely and accessible health care services, the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) has purchased care from non-VA community providers through its care in the community programs since as early as 1945. VHA's agency-wide data show that in fiscal year 2015, it processed about 66 percent of claims within the agency'...
Nonemergency Medical Transportation: Updated Medicaid Guidance Could Help States
GAO-16-238: Published: Feb 2, 2016. Publicly Released: Mar 3, 2016.
The nonemergency medical transportation (NEMT) benefits offered by Medicare and Medicaid differ. Medicare provides NEMT via ambulance only when other means of transportation, such as a taxi or wheelchair van, would jeopardize the health of the beneficiary. Medicaid NEMT is generally available for beneficiaries who have no other means of transportation to medical services. States are responsible fo...
Health Care Fraud: Information on Most Common Schemes and the Likely Effect of Smart Cards
GAO-16-216: Published: Jan 22, 2016. Publicly Released: Feb 22, 2016.
GAO's review of 739 health care fraud cases that were resolved in 2010 showed the following:About 68 percent of the cases included more than one scheme with 61 percent including two to four schemes and 7 percent including five or more schemes.The most common health care fraud schemes were related to fraudulent billing, such as billing for services that were not provided (about 43 percent of cases)...
Veterans' Health Care: Preliminary Observations on VHA's Claims Processing Delays and Efforts to Improve the Timeliness of Payments to Community Providers
GAO-16-380T: Published: Feb 11, 2016. Publicly Released: Feb 11, 2016.
To help ensure that veterans are provided timely and accessible health care services, the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) has purchased care from non-VA community providers through its care in the community programs since as early as 1945. GAO's preliminary work from the sites it visited shows that in fiscal year 2015, VHA's claims processing was sig...
Medicare and Medicaid: Additional Oversight Needed of CMS's Demonstration to Coordinate the Care of Dual-Eligible Beneficiaries
GAO-16-31: Published: Dec 18, 2015. Publicly Released: Jan 19, 2016.
Due to the flexibility that states have in designing their Financial Alignment Demonstrations, the integrated care organizations that GAO interviewed in California, Illinois, Massachusetts, Virginia, and Washington implemented care coordination for dual-eligible Medicare and Medicaid beneficiaries in a variety of ways. For example, these organizations assigned care coordinators to beneficiaries us...
Health Care Workforce: Comprehensive Planning by HHS Needed to Meet National Needs
GAO-16-17: Published: Dec 11, 2015. Publicly Released: Jan 11, 2016.
The Department of Health and Human Services (HHS) engages in some planning for the 72 health care workforce programs administered by its agencies, but lacks comprehensive planning and oversight to ensure that these efforts meet national health care workforce needs. HHS's current strategic plan includes broad strategies—such as improving access to comprehensive primary and preventive medical serv...