Inadequate Controls Over Medicare Payments for Once-in-a-Lifetime Physician Procedures
HRD-84-23
Published: Feb 13, 1984. Publicly Released: Feb 13, 1984.
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Highlights
GAO evaluated the controls that Medicare carriers have over payments for once-in-a-lifetime physician procedures. The Health Care Financing Administration (HCFA) promulgates program regulations and defines such procedures as certain types of surgical operations and initial service visits.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Health Care Financing Administration | The Administrator, HCFA, should enforce the requirement that carriers implement controls for once-in-a-lifetime procedures. |
Closed – Implemented
In October 1984, HCFA issued instructions to the carriers requiring them to screen claims for once-in-a-lifetime procedures.
|
| Health Care Financing Administration | The Administrator, HCFA, should require the Equitable Life Assurance Society to collect all of the overpayments for dialysis treatments that were identified. |
Closed – Implemented
In June 1984, HCFA directed the carriers to pursue the overpayments. The carriers reported, in August 1984, that collections had been made.
|
| Health Care Financing Administration | The Administrator, HCFA, should develop a core list of codes to be controlled as once-in-a-lifetime procedures while implementing the HCFA Common Procedure Coding System and require carriers to have edits for these procedures. |
Closed – Implemented
HCFA is developing a core list of once-in-a-lifetime procedures.
|
| Health Care Financing Administration | The Administrator, HCFA, should examine the desirability of requiring carriers to make use of procedures that can only be performed once on a beneficiary a permanent part of beneficiaries' records. |
Closed – Implemented
HCFA is still studying the desirability of requiring carriers, as a permanent part of a beneficiary's record, to note the performance of once-in-a-lifetime procedures.
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Topics
Cost analysisHealth care cost controlProgram evaluationQuestionable paymentsMedicareOverpaymentsPhysiciansDialysisBeneficiariesHealth care