Managed health care (31 - 40 of 203 items)
Medicare Contracting Reform: Agency Has Made Progress with Implementation, but Contractors Have Not Met All Performance Standards
GAO-10-71: Published: Mar 25, 2010. Publicly Released: Apr 26, 2010.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 significantly reformed contracting for payment of Medicare's $310 billion per year in fee-for-service claims. The Centers for Medicare & Medicaid Services (CMS) is transitioning claims administration to 19 new entities known as Medicare Administrative Contractors (MAC) and plans to complete the process ahead of October 1, 2...
Medicare Part D: CMS Oversight of Part D Sponsors' Fraud and Abuse Programs Has Been Limited, but CMS Plans Oversight Expansion
GAO-10-481T: Published: Mar 3, 2010. Publicly Released: Mar 3, 2010.
Medicare Part D, the voluntary, outpatient prescription drug benefit for eligible individuals 65 years and older and certain individuals with disabilities, is at risk for fraud, waste, and abuse. Part D is administered by the Centers for Medicare & Medicaid Services (CMS). All Part D sponsors--private companies that operate Part D benefit plans--are required to have programs to safeguard the Part...
Medicare Managed Care: Observations about Medicare Cost Plans
GAO-10-185: Published: Dec 28, 2009. Publicly Released: Dec 28, 2009.
Medicare cost plans--managed care plans paid based on the reasonable costs of delivering Medicare-covered services--enroll a small number of beneficiaries compared to Medicare Advantage (MA), Medicare's managed care program in which the plans accept financial risk if their costs exceed fixed payments received for each enrolled beneficiary. Despite the small enrollment, industry representatives sta...
Medicare: Improvements Needed to Address Improper Payments in Home Health
GAO-09-185: Published: Feb 27, 2009. Publicly Released: Mar 13, 2009.
Medicare spending on home health totaled $12.9 billion in 2006, up 44 percent from 2002. Concerns have been raised that improper payments from practices indicating fraud and abuse may have contributed to Medicare home health spending and utilization. The Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare, is responsible for minimizing improper payments made on beh...
Medicare Part D: Opportunities Exist for Improving Information Sent to Enrollees and Scheduling the Annual Election Period
GAO-09-4: Published: Dec 12, 2008. Publicly Released: Dec 12, 2008.
In Medicare Part D, enrollees in stand-alone prescription drug plans (PDPs) are allowed to switch plans during an annual coordinated election period (AEP) set under law from November 15 to December 31, with new coverage effective January 1. The Centers for Medicare & Medicaid Services (CMS) required that plan sponsors send an Annual Notice of Change (ANOC)--using either its model or a nonmodel for...
Medicare Advantage Organizations: Actual Expenses and Profits Compared to Projections for 2006
GAO-09-132R: Published: Dec 8, 2008. Publicly Released: Dec 11, 2008.
The federal government's spending on the Medicare Advantage (MA) program has grown substantially in recent years, from approximately $60 billion in 2006 and $77 billion in 2007 to an estimated $91 billion in 2008. MA organizations provide health care coverage to Medicare beneficiaries through private health plans, thus offering an alternative to the original Medicare fee-for-service (FFS) program...
Medicare Part D Prescription Drug Coverage: Federal Oversight of Reported Price Concessions Data
GAO-08-1074R: Published: Sep 30, 2008. Publicly Released: Oct 30, 2008.
To help Medicare beneficiaries manage the rising cost of prescription drugs, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which established the outpatient prescription drug benefit known as Medicare Part D. The benefit was first available in January 2006, and that year it provided federally subsidized prescription drug coverage for nearly 28 mil...
Medicare Part D: Some Plan Sponsors Have Not Completely Implemented Fraud and Abuse Programs, and CMS Oversight Has Been Limited
GAO-08-760: Published: Jul 21, 2008. Publicly Released: Aug 25, 2008.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established a voluntary outpatient prescription drug benefit, known as Medicare Part D. The Centers for Medicare & Medicaid Services (CMS) contracts with private companies to serve as Part D sponsors and administer the Part D prescription drug benefit plans. To protect beneficiaries and the fiscal integrity of the pro...
Medicare Part B Imaging Services: Rapid Spending Growth and Shift to Physician Offices Indicate Need for CMS to Consider Additional Management Practices
GAO-08-452: Published: Jun 13, 2008. Publicly Released: Jul 14, 2008.
The Centers for Medicare & Medicaid Services (CMS)--an agency within the Department of Health and Human Services (HHS)--and the Congress, through the Deficit Reduction Act of 2005 (DRA), recently acted to constrain spending on imaging services, one of the fastest growing set of services under Medicare Part B, which covers physician and other outpatient services. GAO was asked to provide informatio...
Medicare Advantage Organizations: Actual Expenses and Profits Compared to Projections for 2005
GAO-08-827R: Published: Jun 24, 2008. Publicly Released: Jun 25, 2008.
Medicare Advantage (MA) organizations offer an alternative to the original Medicare fee-for-service (FFS) program. Payments to MA organizations are, in part, based on the revenue and expenditure projections MA organizations submit to the Centers for Medicare & Medicaid Services (CMS)--the agency that administers Medicare--prior to the start of each contract year. Once Medicare payments are determi...