Health care programs (51 - 60 of 104 items)
Marijuana: Early Experiences with Four States' Laws That Allow Use for Medical Purposes
GAO-03-189: Published: Nov 1, 2002. Publicly Released: Nov 29, 2002.
A number of states have adopted laws that allow medical use of marijuana. Federal law, however, does not recognize any accepted medical use for marijuana and individuals remain subject to federal prosecution for marijuana possession. Debate continues over medical effectiveness of marijuana, and over government policies surrounding medical use. State laws in Oregon, Alaska, Hawaii, and California a...
Medicare: Recent CMS Reforms Address Carrier Scrutiny of Physicians' Claims for Payment
GAO-02-693: Published: May 28, 2002. Publicly Released: May 28, 2002.
In 1990, GAO designated the Medicare program to be at high-risk for waste, fraud, and abuse. More than a decade later, Medicare remains on GAO's high-risk list. This report examines Medicare's claims review process, which is designed to detect improper billing or payments. GAO found that most physicians who bill Medicare are largely unaffected by carriers' medical reviews, with 90 percent of physi...
Medicare: Using Education and Claims Scrutiny to Minimize Physician Billing Errors
GAO-02-778T: Published: May 28, 2002. Publicly Released: May 28, 2002.
In its audit for year 2001, the Department of Health and Human Services' Office of Inspector General found that $12.1 billion was improperly paid to Medicare providers. GAO's February report (GAO-02-249) showed that physicians often do not receive complete, accurate, clear, or timely guidance on Medicare billing and payment policies. At the carriers studied, GAO found significant shortcomings in p...
Medicare Outpatient Drugs: Program Payments Should Better Reflect Market Prices
GAO-02-531T: Published: Mar 14, 2002. Publicly Released: Mar 14, 2002.
In some cases, Medicare pays significantly more for covered outpatient drugs than the actual costs to the physicians and pharmacy suppliers. Attempts to reduce these payments have been met with provider claims that overpayments for the drugs are needed to cover underpayments for administering or delivering them. Medicare's method for establishing drug payments is flawed. Medicare pays 95 percent o...
Medicare: Improper Third-Party Billing of Medicare by Behavioral Medical Systems, Inc.
OSI-00-5R: Published: Mar 30, 2000. Publicly Released: Apr 11, 2000.
Pursuant to a congressional request, GAO reviewed the operations of Behavioral Medical Systems, Inc.GAO noted that: (1) while BMS represented itself to the Medicare Program as a provider, in fact it functioned as a broker and a third-party biller; (2) GAO found a consistent pattern by which BMS caused improper Medicare claims to be submitted for services not provided by six psychiatrists; (3) of t...
Health Care Financing Administration: Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2000
OGC-00-9: Published: Nov 15, 1999. Publicly Released: Nov 15, 1999.
Pursuant to a legislative requirement, GAO reviewed the Health Care Financing Administration's (HCFA) new rule on Medicare Program revisions to payment policies under the physician fee schedule for calendar year 2000. GAO noted that: (1) the rule would make several changes affecting Medicare Part B payment; (2) the changes include, among others, implementation of resource-based malpractice insuran...
Physician Performance: Report Cards Under Development but Challenges Remain
HEHS-99-178: Published: Sep 30, 1999. Publicly Released: Nov 1, 1999.
Pursuant to a congressional request, GAO reviewed efforts to provide the public with information on physician performance, focusing on: (1) the issues involved in measuring and reporting on physician and physician group performance; (2) efforts to develop physician report cards; and (3) initiatives under way that may address impediments to measuring physician and physician group performance.GAO no...
Organ Procurement and Transplantation Network: Legal Liability and Data Confidentiality
OGC-99-47R: Published: May 3, 1999. Publicly Released: May 3, 1999.
Pursuant to a congressional request, GAO provided information on the Organ Procurement and Transplantation Network (OPTN), focusing on the impact of proposed Department of Health and Human Services' (HHS) modifications on the: (1) confidentiality of information about the program; and (2) possible legal liability of members of the Network arising from their peer review activities.GAO noted that: (1...
Physician Shortage Areas: Medicare Incentive Payment Not an Effective Approach to Improve Access
HEHS-99-36: Published: Feb 26, 1999. Publicly Released: Feb 26, 1999.
Pursuant to a congressional request, GAO reviewed the Medicare Incentive Payment program to determine if: (1) it is an effective mechanism for improving access to care for Medicare beneficiaries and underserved populations other than Medicare beneficiaries; and (2) the program's goals, performance measures, and financial controls provide a sound structure for continuing or expanding the program.GA...
Medicare Physician Payments: Need to Refine Practice Expense Values During Transition and Long Term
HEHS-99-30: Published: Feb 24, 1999. Publicly Released: Feb 24, 1999.
Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) ongoing efforts to develop resource-based practice expense relative value units (RVUs), focusing on: (1) whether the new methodology is an acceptable approach for revising Medicare's fee schedule; (2) questions about the data, assumptions, and adjustments underlying the new methodology that need to...