Medicare: Increased Federal Oversight of HMO's Could Improve Quality of
and Access to Care (Testimony, 08/03/95, GAO/T-HEHS-95-229).

This testimony discusses problems that the Health Care Financing
Administration (HCFA) has had monitoring health maintenance
organizations (HMO) it contracts with to provide services to Medicare
beneficiaries, and ensuring that they comply with Medicare's performance
standards.  GAO found weaknesses in HCFA's quality assurance monitoring,
enforcement measures, and appeal processes. Although HCFA routinely
reviews HMO operations for quality, these reviews are generally
perfunctory and do not consider the financial risks that HMOs transfer
to providers. Moreover, HCFA collects virtually no data on services
received through HMOs to enable HCFA to identify providers who may be
underserving beneficiaries.  In addition, HCFA's HMO oversight has two
other major limitations: enforcement actions are weak, and the
beneficiary appeal process is slow.  HCFA's current regulatory approach
to ensuring good HMO performance appears to GAO to lag behind the
private sector.

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

 REPORTNUM:  T-HEHS-95-229
     TITLE:  Medicare: Increased Federal Oversight of HMO's Could 
             Improve Quality of and Access to Care
      DATE:  08/03/95
   SUBJECT:  Medicare programs
             Health maintenance organizations
             Beneficiaries
             Contract monitoring
             Noncompliance
             Health care services
             Quality assurance
             Appellate procedure
             Health services administration
IDENTIFIER:  Florida
             
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