Health, Education, Employment, Social Security, Welfare, and Veterans
Reports (Letter Report, 02/01/96, GAO/HEHS-96-89W).

This booklet lists GAO documents on government programs related to
health, education, employment, social security, welfare, and veterans
issues, which are run primarily by the Departments of Health and Human
Services, Labor, Education, and Veterans Affairs. One section identifies
reports and testimony issued during the past month and summarizes key
products. Another section lists all documents published during the past
year, organized chronologically by subject. Order forms are included.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-96-89W
     TITLE:  Health, Education, Employment, Social Security, Welfare, 
             and Veterans Reports
      DATE:  02/01/96
   SUBJECT:  Health care services
             Health care programs
             Educational programs
             Employment or training programs
             Retirement pensions
             Social security benefits
             Welfare benefits
             Veterans benefits
             Managed health care
IDENTIFIER:  Bibliographies
             Medicare Program
             Medicaid Program
             Arizona Medicaid Managed Care Program
             
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Cover
================================================================ COVER


Health, Education, and Human
Services Division Reports

February 1996

HEALTH
EDUCATION
EMPLOYMENT
SOCIAL SECURITY
WELFARE
VETERANS

GAO/HEHS-96-89W



Abbreviations
=============================================================== ABBREV

  DC - District of Columbia
  DOD - Department of Defense
  DOL - Department of Labor
  GAO - General Accounting Office
  HCFA - Health Care Financing Administration
  HEHS - Health, Education, and Human Services Division, GAO
  HHS - Department of Health and Human Services
  HMO - health maintenance organization
  VA - Department of Veterans Affairs

PREFACE
============================================================ Chapter 0

The General Accounting Office (GAO), an arm of the Congress, was
established to independently audit government agencies.  GAO's
Health, Education, and Human Services (HEHS) Division reviews the
government's health, education, employment, social security,
disability, welfare, and veterans programs administered in the
Departments of Health and Human Services, Labor, Education, Veterans
Affairs, and some other agencies.

This file contains selected key reports and testimonies issued by GAO
on these programs in January 1996.  These summaries were taken from
Health, Education, and Human Services Division Reports, a monthly
booklet which contains the following information:

Most Recent GAO Products:  This section identifies reports and
testimonies issued during the past month and provides summaries for
selected key products. 

Comprehensive 1-Year Listings:  This section lists all products
published in the last year, organized chronologically by subject. 
When appropriate, products may be included in more than one subject
area. 

You may obtain single copies of the products free of charge, by
telephoning your request to (202) 512-6000 or faxing it to (301)
258-4066.  Additional ordering details, as well as instructions for
getting on our mailing list, appear at the end of this file. 

You may access the Most Recent GAO Products section of this booklet
on Internet.  Instructions appear on the last two pages of this
booklet.





Janet L.  Shikles
Assistant Comptroller General


MOST RECENT GAO PRODUCTS
(JANUARY 1996)
============================================================ Chapter 1


   HEALTH
---------------------------------------------------------- Chapter 1:1


      SELECTED SUMMARIES
-------------------------------------------------------- Chapter 1:1.1

Medicare:  Millions Can Be Saved by Screening Claims for Overused
Services (Report, 1/30/96, GAO/HEHS-96-49). 

Medicare contractors routinely pay hundreds of millions of dollars in
Medicare claims without first determining if the services provided
are medically necessary.  For each of six groups of medical
procedures GAO reviewed, more than half of the 17 contractors
surveyed were not using prepayment screens to check these claims for
medical necessity.  Even when evidence points to overuse nationwide,
each of the Medicare contractors usually decides on its own which
procedures to screen.  Millions of dollars in Medicare claims for
these six groups of procedures would have been denied if all
contractors had screened the claims for medical necessity.  GAO's
review of 7 of the 17 contractors revealed that between $29 million
and $150 million was paid for claims that may have been medically
unnecessary.  Problems with controlling payments for widely overused
procedures persist because the Health Care Financing Administration
(HCFA) lacks an effective national strategy.  HCFA has not exercised
its statutory authority to take an active role in promoting more
local medical policies and prepayment screens for widely overused
procedures. 

For information on ordering this report, call (202) 512-6000.  For
more information on the topics discussed in this report, contact
William M.  Reis at (617) 565-7488. 

Fraud and Abuse:  Providers Target Medicare Patients in Nursing
Facilities (Report, 1/24/96, GAO/HEHS-96-18). 

Although most providers are honest and bill appropriately, a wide
array of provider types--including durable medical equipment
suppliers, laboratories, physicians, optometrists, and
psychiatrists-- have been involved in the fraudulent or abusive
billing of Medicare for services and supplies furnished to nursing
facility patients.  The wrongdoing has generally focused on billing
Medicare for unnecessary or undelivered services or misrepresenting a
service to obtain reimbursement.  The investigations GAO reviewed
probed activities in over 40 states, with many providers operating in
multiple states.  Although not quantifiable, the evidence suggests
that fraud and abusive billing activities are frequent and
widespread.  Medicare needs to change the way it reimburses for
services and supplies provided to beneficiaries residing in nursing
facilities.  Because these facilities have a primary role in planning
their residents' care, they are in the best position to monitor the
provision of services and supplies.  Although options exist for such
involvement of nursing facilities, all require structural--and
therefore long-term-- changes.  In the meantime, certain incremental
changes would make the nursing facility environment less hospitable
to fraudulent or abusive billing activities. 

For information on ordering this report, call (202) 512-6000.  For
more information on the topics discussed in this report, contact
Barry D.  Tice at (202) 512-7119. 

Medicare HMOs:  Rapid Enrollment Growth Concentrated in Selected
States (Report, 1/18/96, GAO/HEHS-96-63). 

About 2.8 million Medicare beneficiaries--about 7 percent of the
total--were enrolled in risk-contract health maintenance
organizations (HMO) as of August 1995.  This was double the
percentage enrolled in 1987.  The growth has been particularly rapid
in the past 4 years and has centered on certain states.  California
and Florida, for example, have more than half of all enrollees.  The
available data show two key characteristics that are common to many
locations where HMOs have decided to sign risk contracts with
Medicare:  (1) HMOs are relatively well established as medical
providers to the general population and (2) the amount of money the
government pays risk-contract HMOs for each enrollee tends to be
relatively high where enrollment is the highest.  In addition, two
key factors may affect Medicare beneficiaries' decisions to enroll in
HMOs:  (1) HMOs increase their attractiveness by not charging
Medicare's normal deductibles and coinsurance and often providing
services beyond basic coverage and (2) some Medicare beneficiaries
join HMOs to continue receiving medical benefits provided by their
former employers. 

For information on ordering this report, call (202) 512-6000.  For
more information on the topics discussed in this report, contact
Michael F.  Gutowski at (202) 512-7119. 

Health Insurance for Children:  State and Private Programs Create New
Strategies to Insure Children (Report, 1/18/96, GAO/HEHS-96- 35). 

In the mid-1960s, states and private organizations began developing
health insurance programs to increase health care access for
children.  By 1995, 14 states and at least 24 private-sector
organizations had such programs.  The number of children enrolled in
the six programs GAO visited ranged from more than 5,000 to more than
100,000.  These programs operated within fixed and often limited
budgets and were funded by various nonfederal sources.  To better
target their resources, the state- and privately funded programs
restricted eligibility to low-income, uninsured, or underinsured
children.  Nonetheless, limited budgets compelled five of the six
programs to cap enrollment at times and to place eligible children on
waiting lists.  To manage their costs, the programs used several
strategies.  Some limited services covered, but all covered basic
preventive and outpatient services.  Some of the programs that did
not provide inpatient care relied on Medicaid to provide this
service.  Other cost-management strategies included patient cost
sharing through premiums and copayments, enrolling children in
managed care, and using competitive bidding to select insurers.  The
six programs were designed to attract both providers and families. 
Initial surveys suggested that children in these programs increased
their access to and appropriate use of health care. 

For information on ordering this report, call (202) 512-6000.  For
more information on the topics discussed in this report, contact
Sarah F.  Jaggar at (202) 512-7119. 

Medicaid:  Spending Pressures Spur States Toward Program
Restructuring (Testimony, 1/18/96, GAO/T-HEHS-96-75). 

Several factors, including federal mandates that expand eligibility,
medical price inflation, and creative financing schemes, have
contributed to rising Medicaid costs.  To contain these costs, 22
states have recently sought section 1115 waivers from federal
regulations that inhibit their ability to operate extensive managed
care programs.  Some of these states have mandated the enrollment of
their acute care populations--primarily for low-income women and
children--in managed care programs and have expanded coverage to
previously ineligible individuals.  Arizona, which runs a Medicaid
managed care program under a federal waiver obtained over a decade
ago, has lowered Medicaid spending by millions of dollars.  It also
leads the states in its development of information systems for
collecting medical encounter data essential for assessing quality of
care. 

For information on ordering this report, call (202) 512-6000.  For
more information on the topics discussed in this report, contact
Kathryn G.  Allen at (202) 512-7119. 


      OTHER HEALTH PRODUCTS
-------------------------------------------------------- Chapter 1:1.2

State Medicaid Financing Practices (Letter, 1/23/96, GAO/HEHS-
96-76R). 


   EMPLOYMENT
---------------------------------------------------------- Chapter 1:2


      EMPLOYMENT PRODUCTS
-------------------------------------------------------- Chapter 1:2.1

Military Equal Opportunity:  Problems with Services' Complaint
Systems Are Being Addressed by DOD (Report, 1/26/96, GAO/NSIAD-96-
9). 


   VETERANS AFFAIRS AND MILITARY
   HEALTH
---------------------------------------------------------- Chapter 1:3


      VETERANS AFFAIRS AND
      MILITARY HEALTH PRODUCTS
-------------------------------------------------------- Chapter 1:3.1

Fiscal Year 1996 VA Certification (Letter, 1/29/96, GAO/HEHS-96-
84R). 


MAJOR CONTRIBUTORS
============================================================ Chapter 2

Jessie L.  Battle
David W.  Bieritz
Susan Y.  Higgins
James L.  Kirkman
Stephen F.  Palincsar



MAILING LIST REQUEST FORM
============================================================ Chapter 3


         ADDRESS INFORMATION
------------------------------------------------------ Chapter 3:0.0.1

To receive this booklet each month, check here:  .

Name: 
Organization: 
Address: 

Which of the following best describes your organization? 

Congress (2) Other Federal Government (8)
Press (3) State/Local Government (9)
Library (Non-University) (5) Trade/Interest Group (10)
University (6) Law Firm (11)
Private Industry (7) All Others (99)


         AREAS OF INTEREST
------------------------------------------------------ Chapter 3:0.0.2

To receive future reports and testimonies, check your area(s) of
interest. 

HEALTH EMPLOYMENT
Access/Infrastructure (78) Equal Opportunities (00)
Employee/Retiree Benefits (77) High Performance Work (38)
Financing (64) Labor/Mgt.Relations (57)
Health Care Reform (85) Training/Employment
HHS Public Health Service (8) Assistance (60)
Long-Term Care/Aging (73) Workplace Quality (07)
Malpractice (79) Other Employment Issues (47)
Managed Care (80)
Medicare/Medicaid (11) SOCIAL SECURITY, DISABILITY,
Prescription Drugs (81) & WELFARE
Provider Issues (82) Children's Issues (59)
Public Health/Education (83) Pensions (61)
Quality/Practice Standards (25) Social Security & Disability (58)
Substance Abuse/Treatment (84) Welfare (75)
Other Health Issues (86) Other Social Security, Disability
& Welfare Issues (96)
EDUCATION
Department of Education (27)
Early Childhood Develop.  (70) VETERANS AFFAIRS & MILITARY
Armed Forces (35) HEALTH
Elementary/Secondary (02) Military Health (05)
Higher Education (39) Veterans' Benefits (74)
School-to-Work Transition (01) Veterans' Health Care (10)


         FAX OR MAIL TO: 
------------------------------------------------------ Chapter 3:0.0.3

Janet Shikles, Assistant Comptroller General
Health, Education, and Human Services Division, NGB/ACG
U.S.  General Accounting Office
441 G Street, N.W., Washington, D.C., 20548


         (2/96)
------------------------------------------------------ Chapter 3:0.0.4

Fax (202) 512-5806



CHANGE OF ADDRESS NOTIFICATION
FORM
============================================================ Chapter 4


         REQUESTING CHANGES
------------------------------------------------------ Chapter 4:0.0.1

Please complete the following information. 

To change name, organization, or address, enter appropriate changes
below. 

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         FAX OR MAIL TO: 
------------------------------------------------------ Chapter 4:0.0.2

Janet Shikles, Assistant Comptroller General
Health, Education, and Human Services Division, NGB/ACG
U.S.  General Accounting Office
441 G Street, N.W., Washington, D.C., 20548


         (2/96)
------------------------------------------------------ Chapter 4:0.0.3

Fax (202) 512-5806



INTERNET INSTRUCTIONS
============================================================ Chapter 5

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