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Medicare Claims: HCFA Proposal To Establish an Administrative Law Judge Unit

HRD-88-84BR Published: Apr 20, 1988. Publicly Released: Apr 20, 1988.
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Highlights

Pursuant to a legislative requirement, GAO reviewed the Health Care Financing Administration's (HCFA) proposed plan to establish its own hearings and appeals unit to handle Medicare hearings, at an estimated cost of $15 million.

Recommendations

Matter for Congressional Consideration

Matter Status Comments
Congress should require HCFA to test and evaluate the proposal to establish its own hearings and appeals unit separate from that of SSA before implementation. The issues that should be examined in a test include such factors as the: (1) mix of claimants appealing both part A and part B cases; (2) actual telephone acceptance rate of this proposal; (3) possible variations by type of claimant (for example, beneficiaries, physicians); (4) resulting time, case load, and cost of hearings; and (5) performance of the hearings in meeting due process requirements.
Closed – Implemented
Congress did not fund the HCFA proposal.

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Topics

Administrative hearingsAdministrative law judgesAgency missionsClaims settlementElderly personsHealth insuranceHealth insurance cost controlHealth services administrationMedical expense claimsMedicare