Medicare:

Successful Reform Requires Meeting Key Management Challenges

GAO-01-1006T: Published: Jul 25, 2001. Publicly Released: Jul 25, 2001.

Additional Materials:

Contact:

Laura A. Dummit
(202) 512-8942
contact@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

Management of Medicare has come under increasing scrutiny. The Health Care Financing Administration (HCFA) has had mixed success running the program. The agency has developed payment methods that have contained cost growth, and HCFA has paid fee-for-service claims quickly and at low administrative cost. However, HCFA has had difficulty ensuring that it paid claims appropriately. In addition, Medicare claims administration contractors have done a poor job of communicating with Medicare providers. HCFA has taken important steps to address some of these shortcomings, including strengthening payment safeguards, but several factors have hampered its efforts. Despite its growing responsibilities, HCFA suffers from staffing shortages. The agency also continues to rely on archaic computer systems. At the same time, HCFA has faltered in its attempts to adopt a results-based approach to agency management. Constraints on the agency's contracting authority have limited its use of full and open competition to select claims administration contractors and assign administrative tasks. Rising expectations among Medicare beneficiaries and providers are putting pressure on the Centers for Medicare and Medicaid Services to modernize and improve agency operations. Such improvements will require HCFA to begin a performance-based management approach that holds managers accountable for achieving program goals. Congressional attention also appears warranted if Medicare is to meet the challenges of the 21st century.

Mar 26, 2015

Mar 18, 2015

Mar 16, 2015

Mar 9, 2015

Mar 4, 2015

Feb 27, 2015

Feb 23, 2015

Feb 11, 2015

  • government icon, source: Eyewire

    GAO'S 2015 High-Risk Series:

    An Update
    GAO-15-371T: Published: Feb 11, 2015. Publicly Released: Feb 11, 2015.
  • government icon, source: Eyewire

    GAO's 2015 High-Risk Series:

    An Update
    GAO-15-373T: Published: Feb 11, 2015. Publicly Released: Feb 11, 2015.
  • government icon, source: Eyewire

    High-Risk Series:

    An Update
    GAO-15-290: Published: Feb 11, 2015. Publicly Released: Feb 11, 2015.

Looking for more? Browse all our products here