Health insurance cost control (1 - 10 of 267 items)
Medicaid: A Small Share of Enrollees Consistently Accounted for a Large Share of Expenditures
GAO-15-460: Published: May 8, 2015. Publicly Released: May 8, 2015.
A small percentage of Medicaid-only enrollees—that is, those who were not also eligible for Medicare—consistently accounted for a large percentage of total Medicaid expenditures for Medicaid-only enrollees. In each fiscal year from 2009 through 2011, the most expensive 5 percent of Medicaid-only enrollees accounted for almost half of the expenditures for all Medicaid-only enrollees. In contras...
Medicaid: Demographics and Service Usage of Certain High-Expenditure Beneficiaries
GAO-14-176: Published: Feb 19, 2014. Publicly Released: Feb 19, 2014.
In fiscal year 2009, states spent nearly a third (31.6 percent) of all Medicaid expenditures on the most expensive Medicaid-only beneficiaries, who were 4.3 percent of total Medicaid beneficiaries. States spent another third (33.1 percent) on all other Medicaid-only beneficiaries, who represented 81.2 percent of total Medicaid beneficiaries. Among dual eligible beneficiaries, a similar pattern exi...
Medicare: Higher Use of Costly Prostate Cancer Treatment by Providers Who Self-Refer Warrants Scrutiny
GAO-13-525: Published: Jul 19, 2013. Publicly Released: Aug 1, 2013.
The number of Medicare prostate cancer-related intensity-modulated radiation therapy (IMRT) services performed by self-referring groups increased rapidly, while declining for non-self-referring groups from 2006 to 2010. Over this period, the number of prostate cancer-related IMRT services performed by self-referring groups increased from about 80,000 to 366,000. Consistent with that growth, expend...
Federal Employees Health Benefits Program: Premiums Continue to Rise, but Rate of Growth Has Recently Slowed
GAO-07-873T: Published: May 18, 2007. Publicly Released: May 18, 2007.
Average health insurance premiums for plans participating in the Federal Employees Health Benefits Program (FEHBP) have risen each year since 1997. These growing premiums result in higher costs to the federal government and plan enrollees. The Office of Personnel Management (OPM) oversees FEHBP, negotiating benefits and premiums and administering reserve accounts that may be used to cover plans' u...
Federal Employees Health Benefits Program: Competition and Other Factors Linked to Wide Variation in Health Care Prices
GAO-05-856: Published: Aug 15, 2005. Publicly Released: Sep 14, 2005.
Congress is concerned about the health care spending burden facing the Federal Employees Health Benefits Program (FEHBP), the largest private health insurance program in the country. Health care spending per person varies geographically, and the underlying causes for the spending variation have not been fully explored. Understanding market forces and other factors that may influence health care sp...
Medicare: CMS's Program Safeguards Did Not Deter Growth in Spending for Power Wheelchairs
GAO-05-43: Published: Nov 17, 2004. Publicly Released: Dec 15, 2004.
Medicare spending for power wheelchairs--one of the program's most expensive items of durable medical equipment (DME)--rose more than fourfold from 1999 through 2003, while overall Medicare spending rose by about 11 percent for the same period, according to the Centers for Medicare & Medicaid Services (CMS). This spending growth has raised concerns that some of the payments may have been improper...
Medicare: Appropriate Dispensing Fee Needed for Suppliers of Inhalation Therapy Drugs
GAO-05-72: Published: Oct 12, 2004. Publicly Released: Oct 12, 2004.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) revised the payment formula for most of the outpatient drugs, including inhalation therapy drugs, covered under Medicare part B. Under the revised formula, effective 2005, Medicare's payment is intended to be closer to acquisition costs. The Centers for Medicare & Medicaid Services (CMS), the agency that administers M...
Medicare Physician Payments: Concerns about Spending Target System Prompt Interest in Considering Reforms
GAO-05-85: Published: Oct 8, 2004. Publicly Released: Oct 8, 2004.
Concerns were raised about the current system Medicare uses to determine annual changes to physician fees--the sustainable growth rate (SGR) system--when fees were reduced by 5.4 percent in 2002. Subsequent administrative and legislative actions modified or overrode the SGR system, resulting in fee increases for 2003, 2004, and 2005. However, projected fee reductions for 2006-2012 have raised new...
Medicare: CMS Did Not Control Rising Power Wheelchair Spending
GAO-04-716T: Published: Apr 28, 2004. Publicly Released: Apr 28, 2004.
Medicare spending for power wheelchairs, one of the program's most expensive items of durable medical equipment (DME), rose 450 percent from 1999 through 2003, while overall Medicare spending rose by about 11 percent for the same period, according to the Centers for Medicare & Medicaid Services (CMS). This spending growth has raised concerns that Medicare made improper payments and has payment rat...
Medicare: Financial Challenges and Considerations for Reform
GAO-03-577T: Published: Apr 10, 2003. Publicly Released: Apr 10, 2003.
We are pleased to be here today as Congress examines Medicare's financial health and consider the budgetary and economic challenges presented by an aging society. The Comptroller General has been particularly attentive to the sustainability challenges faced by the nation's two largest entitlement programs--Medicare and Social Security--for more than a decade since he served as a public trustee for...