Skip to main content

Medicaid: HCFA Needs Authority to Enforce Third-Party Requirements on States

HRD-91-60 Published: Apr 11, 1991. Publicly Released: May 06, 1991.
Jump To:
Skip to Highlights

Highlights

Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) efforts to ensure that states paid Medicaid funds only after beneficiaries' other health care resources were exhausted, focusing on whether HCFA: (1) identified state noncompliance with federal requirements; and (2) had adequate authority to enforce compliance.

Recommendations

Matter for Congressional Consideration

Matter Status Comments
Congress should amend the Social Security Act to authorize HCFA to withhold federal matching funds when states do not comply with federal third-party requirements. To do so, current restrictions in the law should be removed.
Closed – Implemented
States will be more likely to comply with third-party requirements as a result of the passage of related amendments in the Omnibus Budget Reconciliation Act of 1993, thereby making this recommendation less of a priority.

Full Report

Office of Public Affairs

Topics

Claims processingstate relationsFines (penalties)Health insurance cost controlLaw enforcementMedical expense claimsNoncomplianceRefunds to governmentState-administered programsMedicaid