Medicare (21 - 30 of 108 items)
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...
Prescription Drugs: Overview of Approaches to Control Prescription Drug Spending in Federal Programs
GAO-09-819T: Published: Jun 24, 2009. Publicly Released: Jun 24, 2009.
Millions of individuals receive prescription drugs through federal programs. The increasing cost of prescription drugs has put pressure to control drug spending on federal programs such as the Federal Employees Health Benefits Program (FEHBP), Medicare Part D, the Department of Veterans Affairs (VA), the Department of Defense (DOD), and Medicaid. Prescription drug spending within the FEHBP in part...
Hospital Emergency Departments: Bibliography (GAO-09-348SP, April 30, 2009), an E-supplement to GAO-09-347
GAO-09-348SP: Published: Apr 30, 2009. Publicly Released: Jun 1, 2009.
This is an e-supplement to GAO-09-347. This document presents a bibliography of a literature review conducted as part of our work on emergency department crowding (GAO-09-347). As part of our work to analyze and report on information made available since 2003 about (1) three indicators of emergency department crowding--ambulance diversion, wait times, and patient boarding, and (2) factors that con...
Hospital Emergency Departments: Crowding Continues to Occur, and Some Patients Wait Longer than Recommended Time Frames
GAO-09-347: Published: Apr 30, 2009. Publicly Released: Jun 1, 2009.
Hospital emergency departments are a major part of the nation's health care safety net. Of the estimated 119 million visits to U.S. emergency departments in 2006, over 40 percent were paid for by federally-supported programs. These programs--Medicare, Medicaid, and the State Children's Health Insurance Program--are administered by the Department of Health and Human Services (HHS). There have been...
Medicare and Medicaid Participating Facilities: CMS Needs to Reexamine Its Approach for Funding State Oversight of Health Care Facilities
GAO-09-64: Published: Feb 13, 2009. Publicly Released: Mar 19, 2009.
Americans receive care from tens of thousands of health care facilities participating in Medicare and Medicaid. To ensure the quality of care, CMS contracts with states to conduct periodic surveys and complaint investigations. Federal spending on such activities totaled about $444 million in fiscal year 2007; states are expected to contribute their own funds both through the Medicaid program and a...
Medicare: Callers Can Access 1-800-MEDICARE Services, but Responsibility within CMS for Limited English Proficiency Plan Unclear
GAO-09-104: Published: Dec 29, 2008. Publicly Released: Jan 28, 2009.
The Centers for Medicare & Medicaid Services (CMS) is responsible for providing beneficiaries timely and accurate information about Medicare. Receiving nearly 30 million calls in 2007, 1-800-MEDICARE, operated by a contractor, is the most common way members of the public get program information. The help line provides services both to English-speaking and limited English proficiency (LEP) callers...
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...
Nonprofit Hospitals: Variation in Standards and Guidance Limits Comparison of How Hospitals Meet Community Benefit Requirements
GAO-08-880: Published: Sep 12, 2008. Publicly Released: Oct 14, 2008.
Nonprofit hospitals qualify for federal tax exemption from the Internal Revenue Service (IRS) if they meet certain requirements. Since 1969, IRS has not specified that these hospitals have to provide charity care to meet these requirements, so long as they engage in activities that benefit the community. Many of these activities are intended to benefit the approximately 47 million uninsured indivi...
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: Covert Testing Exposes Weaknesses in the Durable Medical Equipment Supplier Screening Process
GAO-08-955: Published: Jul 3, 2008. Publicly Released: Aug 4, 2008.
According to the Department of Health and Human Services (HHS), schemes to defraud the Medicare program have grown more elaborate in recent years. In particular, HHS has acknowledged Centers for Medicare & Medicaid Service's (CMS) oversight of suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) is inadequate to prevent fraud and abuse. Specifically, weaknesses in...