Beneficiaries (1 - 10 of 77 items) in Custom Date Range
Medicare: CMS's Round 2 Durable Medical Equipment and National Mail-order Diabetes Testing Supplies Competitive Bidding Programs
GAO-16-570: Published: Sep 15, 2016. Publicly Released: Oct 17, 2016.
The number of beneficiaries receiving durable medical equipment (DME) items covered under the competitive bidding program (CBP) generally decreased after implementation of two CBP phases that began July 1, 2013—round 2 and the national mail-order program for diabetes testing supplies. Under the CBP, (administered by the Centers for Medicare & Medicaid Services (CMS)), only competitively selected...
Physician-administered Drugs: Comparison of Payer Payment Methodologies
GAO-16-780R: Published: Aug 1, 2016. Publicly Released: Aug 31, 2016.
Payment methodologies for physician-administered drugs varied across Medicare fee-for-service, Medicaid fee-for-service, the Department of Veterans Affairs (VA) health care system, the VA Choice program, and two large private payers GAO reviewed. Compared to Medicare, other federal payers generally paid rates that were the same or lower. For example, for 10 high-expenditure drugs, VA paid rates th...
Medicare Part B: CMS Should Take Additional Steps to Verify Accuracy of Data Used to Set Payment Rates for Drugs
GAO-16-594: Published: Jul 1, 2016. Publicly Released: Aug 1, 2016.
In 2014, the most recent year for which data were available, the Medicare program and its beneficiaries spent about $21 billion on approximately 46 million administrations of 551 Part B drugs paid based on average sales price (ASP). Six drugs—each exceeding $1 billion in expenditures—accounted for 36 percent of all expenditures on Part B ASP drugs, while a different 10 drugs—each administere...
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)...
Medicare: Increasing Hospital-Physician Consolidation Highlights Need for Payment Reform
GAO-16-189: Published: Dec 18, 2015. Publicly Released: Dec 18, 2015.
Vertical consolidation is a financial arrangement that occurs when a hospital acquires a physician practice and/or hires physicians to work as salaried employees. The number of vertically consolidated hospitals and physicians increased from 2007 through 2013. Specifically, the number of vertically consolidated hospitals increased from about 1,400 to 1,700, while the number of vertically consolidat...
Medicare Part B: Expenditures for New Drugs Concentrated among a Few Drugs, and Most Were Costly for Beneficiaries
GAO-16-12: Published: Oct 23, 2015. Publicly Released: Nov 20, 2015.
New Medicare Part B drugs were more likely than new drugs not paid under Part B to be biologics, that is, products derived from living sources; be approved to treat a narrower range of conditions; and to have used a Food and Drug Administration (FDA) program to expedite their development and review. Sixty-one percent of the 83 new Part B drugs approved by FDA from 2006 through 2013 were biologics,...
Medicare Advantage: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy
GAO-15-710: Published: Aug 31, 2015. Publicly Released: Sep 28, 2015.
The Centers for Medicare & Medicaid Services (CMS) is the agency within the Department of Health and Human Services (HHS) responsible for overseeing the Medicare Advantage (MA) program—Medicare's private plan alternative. Since 2011, CMS has defined an adequate MA provider network as meeting two criteria: a minimum number of providers and maximum travel time and distance to those providers. To r...
Medicaid: Additional Reporting May Help CMS Oversee Prescription-Drug Fraud Controls
GAO-15-390: Published: Jul 8, 2015. Publicly Released: Aug 10, 2015.
GAO found indicators of potential prescription-medication fraud and abuse among thousands of Medicaid beneficiaries and hundreds of prescribers during fiscal year 2011—the most-recent year for which reliable data were available in four selected states: Arizona, Florida, Michigan, and New Jersey. These states accounted for about 13 percent of all fiscal year 2011 Medicaid payments. Specifically,...
Medicare: Results from the First Two Years of the Pioneer Accountable Care Organization Model
GAO-15-401: Published: Apr 22, 2015. Publicly Released: May 22, 2015.
Health care providers and suppliers voluntarily form accountable care organizations (ACO) to provide coordinated care to patients with the goal of reducing spending while improving quality. Within the Centers for Medicare & Medicaid Services (CMS), the Center for Medicare & Medicaid Innovation (CMMI) began testing the Pioneer ACO Model in 2012. Under this model, ACOs can earn additional Medicare p...
Health Care Transparency: Actions Needed to Improve Cost and Quality Information for Consumers
GAO-15-11: Published: Oct 20, 2014. Publicly Released: Nov 18, 2014.
Results obtained from two selected private consumer transparency tools GAO reviewed—websites with health cost or quality information comparing different health care providers—show that some providers are paid thousands of dollars more than others for the same service in the same geographic area, regardless of the quality of such services. For example, the cost for maternity care at selected ac...