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Medicare: Fraud and Abuse Control Pose a Continuing Challenge

HEHS-98-215R Published: Jul 15, 1998. Publicly Released: Jul 15, 1998.
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Highlights

Pursuant to a congressional request, GAO reviewed fraud and abuse in both Medicare's fee-for-service and managed care programs, focusing on: (1) the impact of inadequate program safeguard funding on efforts to combat improper Medicare payments; (2) ineffective management and oversight of fee-for-service payments and operations; and (3) ineffective oversight of Medicare managed care plans.

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Claims processingFraudHealth insuranceHealth insurance cost controlHealth maintenance organizationsInternal controlsMedical expense claimsMedicareProgram abusesBeneficiaries