Internal controls (11 - 20 of 45 items)
Patient Protection and Affordable Care Act: IRS Should Expand Its Strategic Approach to Implementation
GAO-11-719: Published: Jun 29, 2011. Publicly Released: Jun 29, 2011.
This report discusses the briefing we gave on June 8, 2011, as well as subsequent comments from the Internal Revenue Service (IRS). We gave this briefing in response to Congressional request that we assess IRS's planning to implement its responsibilities under the Patient Protection and Affordable Care Act (PPACA). The report (1) describes IRS's PPACA responsibilities and effective dates and (2) a...
Health Care Fraud and Abuse Control Program: Improvements Needed in Controls over Reporting Deposits and Expenditures
GAO-11-446: Published: May 10, 2011. Publicly Released: Jun 9, 2011.
To help combat fraud and abuse in health care programs, including Medicare and Medicaid, Congress enacted the Health Care Fraud and Abuse Control (HCFAC) program as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA requires that the Departments of Health and Human Services (HHS) and Justice (DOJ) issue a joint annual report to Congress on amounts deposited to a...
Medicare Part D: CMS Conducted Fraud and Abuse Compliance Plan Audits, but All Audit Findings Are Not Yet Available
GAO-11-269R: Published: Feb 18, 2011. Publicly Released: Mar 21, 2011.
The Medicare Part D program, administered by the Department of Health and Human Services' (HHS) Centers for Medicare & Medicaid Services (CMS), provides a voluntary, outpatient prescription drug benefit for eligible individuals 65 years and older and eligible individuals with disabilities. CMS contracts with private companies--such as health insurance companies and companies that manage pharmacy b...
Medicare: Program Remains at High Risk Because of Continuing Management Challenges
GAO-11-430T: Published: Mar 2, 2011. Publicly Released: Mar 2, 2011.
In the February 2011 High-Risk Series update, GAO continued designation of Medicare as a high-risk program because its complexity and susceptibility to improper payments, combined with its size, have led to serious management challenges. In 2010, Medicare covered 47 million people and had estimated outlays of $509 billion. The Centers for Medicare & Medicaid Services (CMS) has estimated fiscal yea...
Medicare Recovery Audit Contracting: Lessons Learned to Address Improper Payments and Improve Contractor Coordination and Oversight
GAO-10-864T: Published: Jul 15, 2010. Publicly Released: Jul 15, 2010.
This testimony discusses preventing and addressing government payment errors in the Medicare program. Medicare, which provides health insurance for those aged 65 and older and certain disabled persons, is susceptible to improper payments due to its size and complexity. Because the Medicare program has paid billions of dollars in error each year, the Centers for Medicare & Medicaid Services (CMS)--...
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 Recovery Audit Contracting: Weaknesses Remain in Addressing Vulnerabilities to Improper Payments, Although Improvements Made to Contractor Oversight
GAO-10-143: Published: Mar 31, 2010. Publicly Released: Mar 31, 2010.
The Centers for Medicare & Medicaid Services (CMS) conducted a mandated 3-year project from March 2005 through March 2008 to demonstrate the use of recovery audit contractors (RAC) in identifying Medicare improper payments and recouping overpayments. CMS implemented a mandated national RAC program, which began in March 2009. GAO was asked to examine specific issues that arose during the demonstrat...
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...
VA Health Care: Improved Oversight and Compliance Needed for Physician Credentialing and Privileging Processes
GAO-10-26: Published: Jan 6, 2010. Publicly Released: Jan 6, 2010.
VA has policies to ensure that physicians have appropriate qualifications and clinical abilities through the processes of credentialing, privileging, and continuous monitoring of performance. Results of a VA investigatory report in 2008 cited deficiencies in the Marion, Illinois, VA medical center's (VAMC) credentialing and privileging processes and oversight of its surgical program. This report e...
Defense Health Care: Post-Deployment Health Reassessment Documentation Needs Improvement
GAO-10-56: Published: Nov 19, 2009. Publicly Released: Nov 19, 2009.
The Department of Defense (DOD) implemented the post-deployment health reassessment (PDHRA), which is required to be administered to servicemembers 90 to 180 days after their return from deployment. DOD established the PDHRA program to identify and address servicemembers' health concerns that emerge over time following deployments. This report is the second in response to a Senate Armed Services C...