Medicare Claims: Commercial Technology Could Save Billions Lost to Billing Abuse
AIMD-95-135
Published: May 05, 1995. Publicly Released: May 05, 1995.
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Highlights
Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) potential use of commercial technology to detect Medicare billing errors, focusing on whether: (1) commercial systems could reduce Medicare costs; and (2) HCFA development approach is likely to generate savings comparable to that of commercial systems.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator, HCFA, to require Medicare carriers to use a commercial system to detect code manipulation when processing Medicare claims for physician services and supplies. |
Closed – Implemented
HCFA acquired a license for a commercial system to detect code manipulation when processing Medicare claims for physician services and supplies. In October 1998 HCFA implemented the use of this software by Medicare claims processing contractors.
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Topics
Claims processingCommercial productsCost effectiveness analysisFraudHealth insurance cost controlManagement information systemsMedical expense claimsMedicareOverpaymentsProgram abuses