Medicare Provider Enrollment: Opportunities to Enhance Program Integrity Efforts
GAO-03-185
Published: Mar 17, 2003. Publicly Released: Mar 17, 2003.
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Highlights
Staffing companies that contract with physicians to staff hospital departments--including emergency departments--are not permitted to bill Medicare. In the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, Congress directed GAO to assess the program integrity implications of enrolling these companies and allowing them to bill Medicare. GAO reviewed about 2.8 million emergency department claims for 2000 from five states and assessed whether contractor physicians retained by staffing companies billed Medicare comparably to other emergency department physicians. GAO also evaluated how the lack of information on staffing companies affects efforts to assure Medicare program integrity.
Recommendations
Matter for Congressional Consideration
| Matter | Status | Comments |
|---|---|---|
| In order to enhance Medicare's program integrity, Congress may wish to amend the Social Security Act to permit the reassignment of benefits to staffing companies that retain contractor physicians to treat Medicare beneficiaries so that CMS may enroll these companies if they meet appropriate criteria. |
Closed – Implemented
|
The recently enacted Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173), included a provision permitting the reassignment of benefits to staffing companies that retain contractor physicians. |
| In order to enhance Medicare's program integrity, Congress may wish to amend the Social Security Act to require these staffing companies to seek enrollment in Medicare. |
Closed – Not Implemented
|
The recently enacted Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173), included a provision permitting, but not requiring, the reassignment of benefits to staffing companies that retain contractor physicians. |
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Centers for Medicare & Medicaid Services | To facilitate improvements in program integrity, the CMS Administrator should propose legislation permitting the reassignment of benefits to staffing companies that retain contractor physicians to treat Medicare beneficiaries and requiring that these companies seek enrollment in Medicare. |
Closed – Not Implemented
The recently enacted Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173), contained a provision permitting the reassignment of benefits to staffing companies that retain contractor physicians. As a result, there is no need for the CMS Administrator to propose legislation.
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Comparative analysisHealth care servicesHealth insuranceHospitalsManaged health careMedicarePhysiciansProgram managementHuman resources managementProgram beneficiaries