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Government Accountability Office GAO

GAO: Medicare DME Prior Authorization Programs are Effective

May 22, 2018 - CMS’s prior authorization programs for durable medical equipment (DME) and mobility devices created between $1.1 and $1.9 billion in Medicare savings from 2012 to 2017 by controlling unnecessary spending, according to a new Government Accountability Office (GAO) report. The findings indicate that prior authorization initiatives can be beneficial for payers that need to limit healthcare...


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CMS Value-Based Payment Programs Show Satisfactory Performance

by Thomas Beaton

CMS value-based payment programs, including Medicare accountable care organization (ACO) initiatives, have met many of their goals in recent program years, although some work remains to accelerate growth and achieve federal targets, according...

GAO Finds Several Medicare Beneficiary Data Vulnerabilities

by Thomas Beaton

CMS may have significant Medicare beneficiary data vulnerabilities because of security standards gaps within organizations that review and audit Medicare performance, a new GAO report found. GAO found security risks based on discrepancies in...

GAO: Insufficient Data on Success of 1115 Medicaid Demonstrations

by Thomas Beaton

State and federal evaluations of 1115 Medicaid demonstrations have insufficient data to determine demonstration success because states tend report fragmented program results, according a new GAO report. Currently, there are thirty-four 1115 demonstrations...

Modernizing Medicare Fee-for-Service Cost-Sharing Has Trade Offs

by Thomas Beaton

Medicare’s fee-for-service (FFS) cost-sharing design requires modernization to protect beneficiaries from catastrophic costs, but changing the current design may bring new financial concerns, a new GAO report found. In 2015, eighty-one...

GAO: CMS Needs More Data to Manage Medicare Opioid Risks

by Thomas Beaton

The Government Accountability Office (GAO) has recommended that CMS should collect additional data on Medicare beneficiary opioid risks, including the number of beneficiaries with high-dose opioid prescriptions, the number of providers that overprescribe...

GAO: Medicaid Home, Community Care Create Financial Conflicts

by Thomas Beaton

Home and community-based services (HCBS) programs funded by Medicaid require additional protections from possible financial conflicts of interest, a new GAO report found. Program assessors, including HCBS providers, state and local agencies,...

More Choices for Federal Health Plans Doesn’t Spread Market Share

by Thomas Beaton

The federal health plan market contracted under the Office of Personnel Management (OPM) has remained heavily concentrated over the last decade, despite OPM’s efforts to improve health plan choice for employees enrolled in the Federal Employees...

Claims Analytics Help Medicare Identify, Prevent Provider Fraud

by Thomas Beaton

Close to a quarter of new Medicare fraud investigations started with the use of a claims analytics platform that has helped to save approximately $6.7 million in incorrect billings, a new GAO report found.   After reviewing fraud prevention...

6 Ways VA Can Improve Administrative Management of Care Delivery

by Thomas Beaton

Even though VA has taken steps to improve administration and management of its healthcare delivery systems, the Government Accountability Office (GAO) found six action items that allows the VA to adjust policies that improve data sharing and...

GAO: Veterans Affairs Insurance Enrollment Standards Lacking

by Thomas Beaton

The Department of Veterans Affairs is one of the largest healthcare organizations that provides health benefits, but their enrollment standards and processes lead to delays and errors, according to a new report from the Government Accountability...

GAO: CMS Erroneously Paid $16B to Medicare Advantage Orgs

by Thomas Beaton

CMS incorrectly paid $16 billion to Medicare Advantage organizations (MAOs) as a result of insufficient oversight and mismanagement of data, says the Government Accountability Office (GAO) in a new report. Almost 10 percent of all MA payments...

GAO Report: VA Benefits Appeals Process in Need of Reform

by Thomas Beaton

The Government Accountability Office (GAO) has identified notable inefficiencies in the VA benefits appeals process which have resulted in an average processing wait time of three years.   In its report on the issue, GAO also makes several...

Wait Times Still High for Veterans in VA Choice Program

by Thomas Beaton

Research from the Government Accountability Office (GAO) found that veterans waited an average 24 days to receive care at any care facility that is administered by the Veterans Choice Program. The program allows veterans to receive care from...

GAO: Erroneous Medicaid Claims Data Pose Fraud Risk at CMS

by Thomas Beaton

Millions of people rely on long-term personal care services under Medicaid coverage, but significant gaps and errors in two major CMS data systems are creating significant opportunities for fraud and abuse.   A new report from the Government...

CMS Unlawfully Paid $9M to Beneficiaries for Medicare Services

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) has improperly paid more than $9 million for Medicare services among 481 unlawfully present beneficiaries during the years 2013 and 2014, according to a report from the Department of Health...

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