Medicare: Adapting Private Sector Techniques Could Curb Losses to Fraud
and Abuse (Testimony, 07/19/95, GAO/T-HEHS-95-211).

Medicare's loss of billions of dollars to fraud and abuse could be
curbed by adopting such private sector techniques as competitive
bidding, use of advanced software to detect gross overpayments, and
preferred networks to better control costs.   Medicare's losses stem
from inappropriate pricing and inadequate scrutiny of claims for
payments.  Further, abusive and poorly qualified providers of medical
services and supplies continue to participate in the program.  These
problems are not unique to Medicare.  However, private payers are often
able to react quickly, through a variety of management approaches,
whereas Medicare's pricing methods and controls over utilization, which
were consistent with health care financing and delivery when the program
started, have not been adapted to today's environment.

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

 REPORTNUM:  T-HEHS-95-211
     TITLE:  Medicare: Adapting Private Sector Techniques Could Curb 
             Losses to Fraud and Abuse
      DATE:  07/19/95
   SUBJECT:  Medicare programs
             Claims processing
             Questionable payments
             Program abuses
             Fraud
             Health care services
             Application software
             Medical services rates
             Health care cost control
             Medical expense claims
IDENTIFIER:  HCFA Medicare Transaction System
             
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