Managed health care (41 - 50 of 203 items)
Medicare Advantage: Higher Spending Relative to Medicare Fee-for-Service May Not Ensure Lower Out-of-Pocket Costs for Beneficiaries
GAO-08-522T: Published: Feb 28, 2008. Publicly Released: Feb 28, 2008.
Although private health plans were originally envisioned in the 1980s as a potential source of Medicare savings, such plans have generally increased program spending. In 2006, Medicare paid $59 billion to Medicare Advantage (MA) plans--an estimated $7.1 billion more than Medicare would have spent if MA beneficiaries had received care in Medicare fee-for-service (FFS). MA plans receive a per member...
Medicare Advantage: Increased Spending Relative to Medicare Fee-for-Service May Not Always Reduce Beneficiary Out-of-Pocket Costs
GAO-08-359: Published: Feb 22, 2008. Publicly Released: Feb 28, 2008.
In 2006, the federal government spent about $59 billion on Medicare Advantage (MA) plans, an alternative to the original Medicare fee-for-service (FFS) program. Although health plans were originally envisioned in the 1980s as a potential source of Medicare savings, such plans have generally increased program spending. Payments to MA plans have been estimated to be 12 percent greater than what Medi...
End-of-Life Care: Key Components Provided by Programs in Four States
GAO-08-66: Published: Dec 14, 2007. Publicly Released: Jan 14, 2008.
Approximately 28 percent of all Medicare spending in 1999 was used to provide care for beneficiaries in the last year of their lives. The Medicare hospice benefit is specifically designed for end-of-life care but is an elected benefit for individuals who have a terminal diagnosis with a prognosis of 6 months or less if the disease runs its normal course. GAO was asked to identify examples of progr...
Medicaid: Thousands of Medicaid Providers Abuse the Federal Tax System
GAO-08-17: Published: Nov 14, 2007. Publicly Released: Nov 14, 2007.
In fiscal year 2006, outlays for Medicaid were about $324 billion; about $185 billion was paid by the federal government. Because GAO previously identified abusive and criminal activity associated with government contractors owing billions of dollars in federal taxes, the subcommittee requested GAO expand our work to Medicaid providers. GAO was asked to (1) determine if Medicaid providers have unp...
Defense Health Care: Access to Care for Beneficiaries Who Have Not Enrolled in TRICARE's Managed Care Option
GAO-07-48: Published: Dec 22, 2006. Publicly Released: Dec 22, 2006.
The Department of Defense (DOD) provides health care through its TRICARE program. Under TRICARE, beneficiaries may obtain care through a managed care option that requires enrollment and the use of civilian provider networks, which are developed and managed by contractors. Beneficiaries who do not enroll may receive care through TRICARE Standard, a fee-for-service option, using nonnetwork civilian...
TRICARE: Enrollment of the Department of Defense's TRICARE Beneficiaries in Medicare Part B
GAO-06-489R: Published: Jun 30, 2006. Publicly Released: Jul 31, 2006.
TRICARE is the Department of Defense's (DOD) health care system for active duty and retired uniformed service members and their families. TRICARE consists of four separate programs. Three of these programs--TRICARE Prime, a managed care option; TRICARE Extra, a preferred provider option; and TRICARE Standard, a fee for service option--cover active duty personnel, their dependents, and retirees und...
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 Savings Programs: Results of Social Security Administration's 2002 Outreach to Low-Income Beneficiaries
GAO-04-363: Published: Mar 26, 2004. Publicly Released: Mar 26, 2004.
To assist low-income beneficiaries with their share of premiums and other out-of-pocket costs associated with Medicare, Congress has created four Medicare savings programs. Historic low enrollment in these programs has been attributed to several factors, including lack of awareness about the programs, and cumbersome eligibility determination and enrollment processes through state Medicaid programs...
Medicare: Payment Changes Are Needed for Assistants-at-Surgery
GAO-04-97: Published: Jan 13, 2004. Publicly Released: Jan 13, 2004.
Medicare pays for assistant-atsurgery services under both the hospital inpatient prospective payment system and the physician fee schedule. Payments under the physician fee schedule are limited to a few health professions. In 2001, Congress directed GAO to report on the potential impact on the Medicare program of allowing physician fee schedule payments to Certified Registered Nurse First Assistan...
Medicare Appeals: Disparity between Requirements and Responsible Agencies' Capabilities
GAO-03-841: Published: Sep 29, 2003. Publicly Released: Oct 29, 2003.
Appellants and others have been concerned about the length of time it takes for a decision on the appeal of a denied Medicare claim. In December 2000, the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), required, among other things, shorter decision time frames. BIPA's provisions related to Medicare appeals were to be applied to claims denied after October 1,...