Medicare: Statutory Modifications Needed for the Peer Review Program Monetary Penalty
HRD-89-18
Published: Mar 30, 1989. Publicly Released: Mar 30, 1989.
Skip to Highlights
Highlights
GAO reviewed the Department of Health and Human Services' (HHS) Office of the Inspector General's (OIG) actions on monetary penalties recommended by peer review organizations (PRO) against hospitals and physicians for improper or unnecessary health care services to Medicare beneficiaries.
Recommendations
Matter for Congressional Consideration
| Matter | Status | Comments |
|---|---|---|
| The Senate Committee on Finance, the House Committee on Energy and Commerce, and the House Committee on Ways and Means should develop legislation amending section 1156 of the Social Security Act to set a fixed upper limit on the size of monetary penalties in lieu of the current cost-based limit. |
Closed – Not Implemented
|
The HHS Inspector General has made a similar recommendation. HHS also supports the recommendation and included it as part of its annual legislative proposals. Bills have been introduced in the House and Senate that would implement the recommendation. No action has resulted. |
| The Senate Committee on Finance, the House Committee on Energy and Commerce, and the House Committee on Ways and Means should develop legislation amending section 1156 of the Social Security Act to set a fixed upper limit on the size of monetary penalties in lieu of the current cost-based limit. |
Closed – Not Implemented
|
The HHS Inspector General has made a similar recommendation. HHS also supports the recommendation and included it as part of its annual legislative proposals. Bills have been introduced in the House and Senate that would implement the recommendation. No action has resulted. |
| The Senate Committee on Finance, the House Committee on Energy and Commerce, and the House Committee on Ways and Means should develop legislation amending section 1156 of the Social Security Act to set a fixed upper limit on the size of monetary penalties in lieu of the current cost-based limit. |
Closed – Not Implemented
|
The HHS Inspector General has made a similar recommendation. HHS also supports the recommendation and included it as part of its annual legislative proposals. Bills have been introduced in the House and Senate that would implement the recommendation. Congress, however, has not acted. |
Full Report
Office of Public Affairs
Topics
Administrative remediesContract performanceFines (penalties)Health care cost controlHospital care servicesMedicarePatient care servicesPhysiciansPolicy evaluationQuality assurance