Medicare: HCFA Faces Multiple Challenges to Prepare for the 21st Century
(Testimony, 01/29/98, GAO/T-HEHS-98-85).

Pursuant to a congressional request, GAO discussed the Health Care
Financing Administration's (HCFA) ability to meet growing program
management challenges, focusing on: (1) HCFA's new authorities under
recent Medicare legislation; (2) HCFA managers' views on the agency's
capacity to carry out various Medicare-related functions; and (3) the
actions HCFA needs to take to accomplish its objectives over the next
several years.

GAO noted that: (1) substantial program growth and greater
responsibilities appear to be outstripping HCFA's capacity to manage its
existing workload; (2) legislative reforms have increased HCFA's
authority to manage the Medicare program; (3) simultaneously, however,
other factors have increased the challenges HCFA faces, including the
need to make year 2000 computer adjustments and develop a new,
comprehensive information management strategy; manage transitions in its
network of claims processing contractors; and implement a major agency
reorganization; (4) in addition, officials report that the expertise to
carry out HCFA's new functions is not yet in place and that HCFA has
experienced a loss of institutional knowledge through attrition; (5) in
this environment, agency managers are concerned that some of their
responsibilities might be compromised or neglected altogether because of
higher-priority work; (6) HCFA's approach for dealing with its
considerable workload is incomplete; (7) heretofore, the agency lacked
an approach--consistent with the requirement of the Government
Performance and Results Act of 1993 to develop a strategic plan--that
specified the full range of program objectives to be accomplished; (8)
HCFA has developed a schedule for responding to recent legislative
reforms but is still in the process of detailing the staffing and skill
levels required to meet reform implementation deadlines; and (9) while
addressing new mandates, the agency also needs to specify how it will
continue to carry out its ongoing critical functions.

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

 REPORTNUM:  T-HEHS-98-85
     TITLE:  Medicare: HCFA Faces Multiple Challenges to Prepare for the 
             21st Century
      DATE:  01/29/98
   SUBJECT:  Federal agency reorganization
             Health care programs
             Claims processing
             Human resources utilization
             Managed health care
             Quality assurance
             Medical services rates
IDENTIFIER:  Medicare Program
             
******************************************************************
** This file contains an ASCII representation of the text of a  **
** GAO report.  Delineations within the text indicating chapter **
** titles, headings, and bullets are preserved.  Major          **
** divisions and subdivisions of the text, such as Chapters,    **
** Sections, and Appendixes, are identified by double and       **
** single lines.  The numbers on the right end of these lines   **
** indicate the position of each of the subsections in the      **
** document outline.  These numbers do NOT correspond with the  **
** page numbers of the printed product.                         **
**                                                              **
** No attempt has been made to display graphic images, although **
** figure captions are reproduced.  Tables are included, but    **
** may not resemble those in the printed version.               **
**                                                              **
** Please see the PDF (Portable Document Format) file, when     **
** available, for a complete electronic file of the printed     **
** document's contents.                                         **
**                                                              **
** A printed copy of this report may be obtained from the GAO   **
** Document Distribution Center.  For further details, please   **
** send an e-mail message to:                                   **
**                                                              **
**                                            **
**                                                              **
** with the message 'info' in the body.                         **
******************************************************************


Cover
================================================================ COVER


Before the Subcommittee on Health, Committee on Ways and Means, House
of Representatives

For Release on Delivery
Expected at 10:00 a.m.
Thursday, January 29, 1998

MEDICARE - HCFA FACES MULTIPLE
CHALLENGES TO PREPARE FOR THE 21ST
CENTURY

Statement of William J.  Scanlon, Director
Health Financing and Systems Issues
Health, Education, and Human Services Division

GAO/T-HEHS-98-85

GAO/HEHS-98-85T


(101708)


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

  BBA - Balanced Budget Act of 1997
  HCFA - Health Care Financing Administration
  HHS - epartment of Health and Human Services
  HIPAA - Health Insurance Portabilty and Accountability Act of 1996
  HMO - health maintenance organizations
  PPO - preferred provider organizations
  PSO - provider sponsored organizations

HCFA FACES MULTIPLE CHALLENGES TO
PREPARE FOR THE 21ST CENTURY
===================================================== Chapter MEDICARE

Mr.  Chairman and Members of the Committee: 

We are pleased to be here today as you discuss the Health Care
Financing Administration's (HCFA) preparedness for administering the
Medicare program in the 21st century.  Because the $200 billion
Medicare program is critical to nearly all elderly Americans (those
aged 65 and older) and to many of the nation's disabled, program
management, excessive spending, and depletion of the Medicare Trust
Fund have been the subject of much congressional concern and scrutiny
in recent years.  We, the Department of Health and Human Services'
(HHS) Inspector General, and others have frequently reported that too
much is being spent inappropriately because of the fraudulent and
abusive billing practices of health care providers, thus prompting
congressional concern about program vulnerabilities.  (See the list
of related GAO products at the end of this statement.)

You asked us to comment on HCFA's ability to meet growing program
management challenges.  My statement today centers on HCFA's
administration of the Medicare program, although HCFA also has shared
responsibilities with the states for administering Medicaid, a
program serving low-income Americans.  More specifically, my remarks
will focus on (1) HCFA's new authorities under recent Medicare
legislation, (2) HCFA managers' views on the agency's capacity to
carry out various Medicare-related functions, and (3) the actions
HCFA needs to take to accomplish its objectives over the next several
years. 

To do this work, we obtained agency documents on HCFA's
reorganization and revised processes and interviewed top agency
officials, including the new Administrator.  In addition, we
conducted small focus groups attended by about 60 senior and midlevel
managers.  We also relied on our previous and ongoing work on
Medicare. 

In summary, substantial program growth and greater responsibilities
appear to be outstripping HCFA's capacity to manage its existing
workload.  Legislative reforms have increased HCFA's authority to
manage the Medicare program.  Simultaneously, however, other factors
have increased the challenges HCFA faces, including the need to make
year 2000 computer adjustments and develop a new, comprehensive
information management strategy; manage transitions in its network of
claims processing contractors; and implement a major agency
reorganization.  In addition, officials report that the expertise to
carry out HCFA's new functions is not yet in place and that HCFA has
experienced a loss of institutional knowledge through attrition.  In
this environment, agency managers are concerned that some of their
responsibilities might be compromised or neglected altogether because
of higher-priority work. 

HCFA's approach for dealing with its considerable workload is
incomplete.  Heretofore, the agency lacked an approach--consistent
with the requirement of the Government Performance and Results Act of
1993 to develop a strategic plan--that specified the full range of
program objectives to be accomplished.  HCFA has developed a schedule
for responding to recent legislative reforms but is still in the
process of detailing the staffing and skill levels required to meet
reform implementation deadlines.  While addressing new mandates, the
agency also needs to specify how it will continue to carry out its
ongoing critical functions. 


   BACKGROUND
--------------------------------------------------- Chapter MEDICARE:1

The size and nature of the Medicare program make HCFA unique in
authority and responsibility among health care payers. 
Fee-for-service Medicare serves about 33 million beneficiaries and
processes a high volume of claims--an estimated 900 million in fiscal
year 1997--from hundreds of thousands of providers, such as
physicians, hospitals, skilled nursing facilities, home health
agencies, and medical equipment suppliers.  HCFA is also responsible
for paying and monitoring more than 400 managed care health plans
that serve more than 5 million beneficiaries.  Enrollment in these
plans has been growing by about 85,000 beneficiaries monthly. 

The Medicare statute divides benefits into two parts:  (1) "hospital
insurance," or part A, which covers inpatient hospital, skilled
nursing facility, hospice, and certain home health care services, and
(2) "supplementary medical insurance," or part B, which covers
physician and outpatient hospital services, diagnostic tests, and
ambulance and other medical services and supplies.  In fiscal year
1997, part A covered an estimated 39 million aged and disabled
beneficiaries, while a slightly smaller number were covered by part
B, which requires payment of a monthly premium. 

In Medicare's fee-for-service program--used by about 87 percent of
the program's beneficiaries--physicians, hospitals, and other
providers submit claims and are paid for each service rendered to
Medicare beneficiaries.  Medicare's managed care program covers a
growing number of beneficiaries who have chosen to enroll in a
prepaid health plan rather than purchase medical services from
individual providers.  The managed care program, which is funded from
both the part A and part B trust funds, currently consists mostly of
risk contract health maintenance organizations (HMO).\1 Medicare pays
these HMOs a monthly amount, fixed in advance, for all the services
provided to each beneficiary enrolled. 

HCFA, an agency within HHS, has slightly less than 4,000 full-time
employees, 65 percent of whom work in the agency's headquarters
offices; the rest work in the agency's 10 regional offices across the
country.  In addition to the agency's workforce, HCFA oversees more
than 60 claims processing contractors that are insurance
companies--like Blue Cross and Blue Shield plans, Mutual of Omaha,
and CIGNA.  In fiscal year 1997, the contractors employed an
estimated 22,200 people to perform Medicare claims processing and
review functions. 


--------------------
\1 The Medicare managed care program also includes cost contract HMOs
and health care prepayment plans.  Cost contract HMOs allow
beneficiaries to choose health services from their HMO network or
outside providers.  Health care prepayment plans may cover only part
B services.  Together, both types of plans enroll less than 2 percent
of the Medicare population. 


   LEGISLATIVE REFORMS
   SUBSTANTIALLY INCREASE HCFA'S
   AUTHORITY TO MANAGE THE
   MEDICARE PROGRAM
--------------------------------------------------- Chapter MEDICARE:2

Two recent acts grant HCFA substantial authority and responsibility
to reform Medicare.  The Health Insurance Portability and
Accountability Act of 1996 (HIPAA), P.L.  104-191, provides the
opportunity to enhance Medicare's anti-fraud-and-abuse activities. 
The Balanced Budget Act of 1997 (BBA), P.L.  105-33, introduces new
health plan options and major payment reforms.  In correspondence to
this Subcommittee last October, we noted that these two pieces of
legislation addressed in large measure our concerns and those of the
HHS Inspector General regarding the tools needed to combat fraud and
abuse.\2 They also address many of the weaknesses discussed in our
High-Risk Series report on Medicare.\3

HIPAA created for the first time a stable source of funding for
Medicare fraud control.  For fiscal year 1997, the act provides for
up to $440 million for program safeguard activities; the level will
rise incrementally each year, reaching $720 million in fiscal year
2003, after which it will remain constant.  This was a significant
step in reversing the trend of declining program safeguard funds
relative to program growth in the 8 years prior to fiscal year 1997,
when HIPAA funding provisions became effective.  This funding comes
from a HIPAA-established fraud-and-abuse control account that also
funds other activities involving other HHS agencies and the
Department of Justice.  HIPAA also provides HCFA with explicit
authority to contract with firms outside its existing claims
processing contractor network to perform payment safeguard functions
while avoiding conflicts of interest.  HIPAA also adds new civil and
criminal penalties to heretofore little-used enforcement powers. 

BBA provides for a dramatic expansion of health plan choices
available to Medicare beneficiaries and makes reforms to payment
methods in traditional fee-for-service Medicare and managed care. 
Under the act's new Medicare+Choice program, beneficiaries will have
new health plan options, including preferred provider organizations
(PPO), provider sponsored organizations (PSO), and private
fee-for-service plans.  Medicare+Choice introduces new consumer
information and protection provisions, including a requirement to
disseminate comparative information on Medicare+Choice plans in
beneficiaries' communities and a requirement that all Medicare+Choice
plans obtain external review from an independent quality assurance
organization.\4 These provisions address problems we have worked to
correct with this committee and others in the Congress.\5

BBA also provided for revamping many of Medicare's decades-old
payment systems to contain the unbridled growth in certain program
components.  Specifically, the act mandated prospective payment
systems for services provided by about 1,100 inpatient rehabilitation
facilities, 14,000 skilled nursing facilities, 5,000 hospital
outpatient departments, and 8,900 home health agencies.  In addition,
it made changes to the payment methods for hospitals, including
payments for direct and indirect medical education costs.  It also
adjusted fee schedule payments for physicians and durable medical
equipment and authorized the conversion of the remaining reasonable
charge payment systems to fee schedules.  Finally, the act granted
the authority to conduct demonstrations on the cost-effectiveness of
purchasing items and services through competitive bids from suppliers
and providers. 


--------------------
\2 See Medicare Fraud and Abuse:  Summary and Analysis of Reforms in
the Health Insurance Portability and Accountability Act of 1996 and
the Balanced Budget Act of 1997 (GAO/HEHS-98-18R, Oct.  9, 1997). 

\3 See High-Risk Series:  Medicare (GAO/HR-97-10, Feb.  1997). 

\4 BBA authorized the HHS Secretary, subject to appropriations, to
collect $200 million in user fees to conduct information activities
associated with Medicare+Choice.  Subsequently, in the HHS
appropriation, the Secretary was given authority to collect $95
million of the originally authorized amount for this purpose.  HCFA
was also appropriated between $20 million and $30 million for the
administration of BBA-related activities. 

\5 See Medicare:  HCFA Should Release Data to Aid Consumers, Prompt
Better HMO Performance (GAO/HEHS-97-23, Oct.  22, 1996) and Medicare: 
Opportunities Are Available to Apply Managed Care Strategies
(GAO/T-HEHS-95-81, Feb.  10, 1995). 


   HCFA'S CAPACITY TO ACCOMPLISH
   ITS MISSION IS DIMINISHING
   RELATIVE TO ADDED
   RESPONSIBILITIES
--------------------------------------------------- Chapter MEDICARE:3

While legislative reforms are dramatically reshaping Medicare, other
changes are occurring, thus compounding difficult management
challenges.  For example, HCFA is rethinking its strategy to develop,
modernize, or otherwise improve the agency's multiple automated
claims processing and other information systems.  This will involve
preparing systems for the year 2000, repairing the deteriorating
managed care enrollment systems, and making the necessary
modifications to existing systems.  HCFA plans to make these changes
as an interim measure until, consistent with the Information
Technology Management Reform Act of 1996 (P.L.  104-106),
comprehensive reengineering can take place, such as making claims
processing systems and payment mechanisms more efficient, programming
BBA payment changes, and modernizing the anti-fraud-and-abuse system
software.\6 HCFA is also confronting transition problems resulting
from the recent loss of large-volume claims processing contractors
and the need for remaining contractors to absorb the workload. 
Finally, HCFA recently restructured its organizational units to
better focus on its mission and is experiencing the kind of
disruptions common to organizational transitions. 

Against this backdrop, the themes that emerged from our individual
interviews and focus groups with HCFA managers centered on (1)
distribution of agency resources, (2) need for specialized expertise,
(3) loss of institutional experience, and (4) reorganization issues. 


--------------------
\6 See Medicare Automated Systems:  Weaknesses in Managing
Information Technology Hinder Fight Against Fraud and Abuse
(GAO/T-AIMD-97-176, Sept.  29, 1997). 


      HEIGHTENED RESPONSIBILITIES
      RESULT IN REDIRECTED
      PRIORITIES
------------------------------------------------- Chapter MEDICARE:3.1

"Robbing Peter to pay Paul" was the expression used to characterize
one of the major themes from our focus groups.  Specifically,
managers were concerned that because of the concentrated efforts to
implement BBA and solve computer problems that could arise in the
year 2000, the quality of other work might be compromised or tasks
might be neglected altogether.  However, managers also noted that
whereas some BBA-related tasks are completely new--such as conducting
an open enrollment period for Medicare+Choice plans--and therefore
add to the workload, others merely formalize work that was already
underway but impose deadlines for completion, such as developing
prospective payment methods for reimbursing several types of health
care providers. 

Regional and headquarters officials responsible for the oversight of
claims processing contractors told us that their capacity to monitor
contractors had seriously diminished.  For example, one region that
formerly had six staff members dedicated to contractor oversight
currently has two; the others, they said, had been reassigned to work
on managed care issues.  This concerns us in light of our work on
Medicare program management.  Over the past several years, we have
reported that HCFA has not adequately ensured that contractors are
paying only medically necessary or otherwise appropriate claims. 

Similarly, the HHS Inspector General's fiscal year 1996 financial
audit found contractor oversight weaknesses.  For example, some
contractors selected for audit could not readily verify total
Medicare expenditures, including paid claim amounts, to ensure that
amounts were accurate, supported, and properly classified; did not
adequately document accounts receivable; and did not have adequate
internal controls over the receipt and disbursement of cash. 
Further, HCFA does not have a method for estimating the amount of
improper Medicare payments; for fiscal year 1996, the Inspector
General estimated that HCFA made about $23 billion in inappropriate
payments. 


      NEW INITIATIVES CREATE NEED
      FOR NEW SKILLS
------------------------------------------------- Chapter MEDICARE:3.2

Managers also expressed a common concern about the staff's mix and
level of skills.  They noted that HCFA's traditional approach of
hiring generalist staff and training them largely on the job is no
longer well suited to the agency's need to implement recent reforms
expeditiously.  Instead, managers are beginning to identify the need
for staff with specialized technical expertise, such as computer
system analysts, survey statisticians, data analysts, market
researchers, information management specialists, managed care
experts, and health educators.  In our discussions, several managers
placed "appropriate skill sets" at the top of their wish lists. 

As an illustration, the Medicare+Choice program introduces new health
plan types and requires the dissemination of information about the
plans to beneficiaries in 1998.  Called the Medicare+Choice
Information Fair, this nationwide educational and publicity campaign
will be the first effort of its kind for HCFA.  Managers were
concerned that staff without prior experience will need to pull
together information that describes and evaluates the merits of
various plans. 

Similar concerns emerged from our discussions about the lack of
specialists in other program and agency support areas.  Some managers
noted the need for highly trained staff to develop, maintain, and
modernize Medicare's government-owned claims processing and other
automated data systems.  They also cited the need for specialists in
contracting, facilities management, and telecommunications. 


      RETIREMENTS AND OTHER
      DEPARTURES DRAIN HCFA OF
      EXPERIENCED STAFF
------------------------------------------------- Chapter MEDICARE:3.3

Many senior and midlevel managers and experienced technical staff
have retired in recent years or are eligible to retire soon.  Almost
40 percent of the organization has turned over in the past 5 years. 
Many were said to have spent their entire careers focused on a
particular aspect of the Medicare program.  A common concern in our
discussions was the erosion of experienced staff to perform a variety
of tasks, such as writing regulations and developing payment systems. 

Managers cited the loss of experienced staff as a problem for
developing and implementing the various prospective payment systems
mandated by BBA.  They also noted that developing one new payment
system would have been manageable, but losses of expert staff make it
difficult to implement multiple new payment systems concurrently. 
For example, experienced staff are needed to perform such technical
tasks as those we mentioned in our October statement before this
Subcommittee, including collecting reliable cost and utilization data
to compute the new prospective payment rates, developing case mix
adjusters, auditing cost reports to avoid incorporating inflated
costs into the base rates, and monitoring to guard against providers'
skimping on services to increase profits.\7

Our focus group participants emphasized that it will be difficult to
replace its experienced staff in the short term.  Although HCFA is
planning to hire new people, the time typically needed for
recruiting, hiring, and orienting new employees is considerable. 
Managers commented that new employees, although highly educated and
motivated, sometimes need extensive on-the-job training to replace
lost expertise. 


--------------------
\7 Medicare:  Recent Legislation to Minimize Fraud and Abuse Requires
Effective Implementation (GAO/T-98-9, Oct.  9, 1997). 


      HCFA'S REORGANIZATION IS IN
      TRANSITION
------------------------------------------------- Chapter MEDICARE:3.4

In July 1997, HCFA restructured its entire organization.  The new
design reflected the agency's intent to, among other things, (1)
combine activities to redirect additional resources to the growing
managed care side of the program, (2) acknowledge a shift from HCFA's
traditional role as claims payer to a more active role as purchaser
of health care services, and (3) establish three components focused
on beneficiaries, health plans and providers, and Medicaid and other
activities conducted at the state level.  It also established
technical and support offices to assist these components.  (See
HCFA's organization chart in app.  I.) In announcing the planned
reorganization, the Administrator explained that as Medicare has
evolved over the years, new programs and projects were layered onto
existing structures.  Over time, he noted, this became cumbersome and
confusing. 

Many managers we spoke with considered the reorganization to be
theoretically sound.  Some also told us that it was long overdue,
because HCFA's structure encouraged work on narrow issues within
self-contained groups--an approach that did not benefit from the
expertise existing across the agency.  However, a consensus of focus
group participants and high-level officials believed that the timing
of the reorganization's implementation is unfortunate.  They
explained that they are currently facing full agendas with tight
deadlines, which add to the stresses associated with any
organizational change. 

Managers described their difficulties in establishing new
communication and coordination links within units as well as across
the agency.  For some, new efforts to coordinate have proved
time-consuming to the point of being counterproductive.  Managers
commented that sign-off sheets formalizing coordination have enough
names to take on the appearance of a staff roster. 

They noted that the situation was particularly acute in light of the
fact that people have not yet moved to the actual location of their
new units.  Managers in one division said staff were scattered in as
many as seven places around HCFA's building.  HCFA now hopes to have
staff relocated by late spring, although this plan appears to be
optimistic. 


   HCFA LACKS A COMPREHENSIVE PLAN
   TO ACCOMPLISH ITS SHORT-TERM
   AGENDA
--------------------------------------------------- Chapter MEDICARE:4

We observed that managers appeared to be clear on top management's
expectations for completing BBA-related activities and for making
sure that contractors' claims processing systems would comply with
the millennium changes.  They were less certain, however, about the
agency's strategy for meeting other mission-related work. 

To articulate the importance of BBA, HCFA established a tracking
system that enumerates all the activities related to BBA mandates,
identifies responsible agency units, and specifies completion
deadlines.  HCFA recently required lead units to prepare detailed BBA
project plans that outline tasks, time periods, and resource needs. 
However, we did not find similar plans to detail the activities for
other agency priorities or ongoing Medicare functions.  As a result,
HCFA does not have a comprehensive view of its workload that would
enable the agency's senior decisionmakers to consider whether
resources are, in fact, adequate or properly distributed and which
activities could be at risk of being neglected. 

One example that came to our attention concerned the legislative
mandates for reporting to the Congress on specific activities and
programs.  Currently, neither top management nor the Office of
Legislation compiles a list of reports due and their deadlines.  Unit
managers are concerned because, although they are aware that certain
reports for which they are responsible will be late, there is no
systematic way to keep top management informed.  Top management, in
turn, cannot decide to heighten the priority for a particular report
or develop a strategy to mitigate the consequences of others being
late. 

The illustration above and our discussions with agency officials
suggest that while HCFA may be ready to assert its BBA-related
resource needs, it is not likely to be in a position to adequately
justify the resources it seeks to carry out its other Medicare
program objectives.  This observation calls to mind our July 1997
report on the adequacy of HHS's draft strategic plan under the
Government Performance and Results Act.\8 We noted that the plan
failed to address certain major management challenges, including
Medicare-related problems.  Specifically, the plan did not address
long-standing concerns about Medicare's existing claims processing
systems or HCFA's efforts to acquire a billion-dollar integrated
database system.  In addition, it did not address the issue of
information security that was identified in the fiscal year 1996
financial statement audit of HCFA, specifying that systems weaknesses
created the risk of unauthorized access to sensitive medical history
and claims data. 


--------------------
\8 The Results Act:  Observations on the Department of Health and
Human Services' April 1997 Draft Strategic Plan (GAO/HEHS-97-173R,
July 11, 1997). 


   OBSERVATIONS
--------------------------------------------------- Chapter MEDICARE:5

HCFA is an agency facing many challenges.  Even before BBA made major
changes, Medicare was a vast and complex program.  Volumes of reports
by us and others demonstrate, in numerous areas, HCFA's need to
address program vulnerabilities.  Because of the risks associated
with a program of Medicare's magnitude, the need for HCFA to be
vigilant cannot be overstated. 

HIPAA and BBA have given HCFA many of the tools it needs to tame and
police excessive spending.  Although some resources accompanied
HCFA's new authorities, senior and midlevel managers contend that
HCFA is struggling to carry out Medicare's numerous and challenging
activities.  In addition, they assert that the loss of experienced
staff has further diminished HCFA's capacity.  Nevertheless, senior
managers do not appear to be adequately informed about the status of
the full range of Medicare activities or associated resource needs. 
Under these circumstances, HCFA seems to be focusing most of its
energy on important deadlines and pressures, but other critical
functions may be receiving back-burner attention. 

We have work underway to assess the status of HCFA's efforts to
implement aspects of HIPAA and BBA and modernize the agency's
information systems.  We will also continue to monitor the progress
of HCFA's reorganization efforts. 


------------------------------------------------- Chapter MEDICARE:5.1

Mr.  Chairman, this concludes my statement.  I will be happy to
answer your questions. 


HCFA'S ORGANIZATION
=========================================================== Appendix I



   (See figure in printed
   edition.)

RELATED GAO PRODUCTS

Medicare:  Effective Implementation of New Legislation Is Key to
Reducing Fraud and Abuse (GAO/HEHS-98-59R, Dec.  3, 1997). 

Medicare Fraud and Abuse:  Summary and Analysis of Reforms in the
Health Insurance Portability and Accountability Act of 1996 and the
Balanced Budget Act of 1997 (GAO/HEHS-98-18R, Oct.  9, 1997) and
related testimony entitled Recent Legislation to Minimize Fraud and
Abuse Requires Effective Implementation (GAO/T-HEHS-98-9, Oct.  9,
1997). 

Medicare Automated Systems:  Weaknesses in Managing Information
Technology Hinder Fight Against Fraud and Abuse (GAO/T-AIMD-97-176,
Sept.  29, 1997). 

Medicare Home Health Agencies:  Certification Process Is Ineffective
in Excluding Problem Agencies (GAO/T-HEHS-97-180, July 28, 1997). 

Medicare:  Need to Hold Home Health Agencies More Accountable for
Inappropriate Billings (GAO/HEHS-97-108, June 13, 1997). 

Medicare Managed Care:  HMO Rates, Other Factors Create Uneven
Availability of Benefits (GAO/HEHS-97-133, May 19, 1997). 

Medicare (GAO/HR-97-10) and related testimony entitled Medicare: 
Inherent Program Risks and Management Challenges Require Continued
Federal Attention (GAO/T-HEHS-97-89, Mar.  4, 1997). 

Medicare:  HCFA Should Release Data to Aid Consumers, Prompt Better
HMO Performance (GAO/HEHS-97-23, Oct.  22, 1996). 

Medicare:  Millions Can Be Saved by Screening Claims for Overused
Services (GAO/HEHS-96-49, Jan.  30, 1996). 

Medicare:  Excessive Payments for Medical Supplies Continue Despite
Improvements (GAO/HEHS-95-171, Aug.  8, 1995). 

Medicare:  Increased HMO Oversight Could Improve Quality and Access
to Care (GAO/HEHS-95-155, Aug.  3, 1995). 

Medicare:  Inadequate Review of Claims Payments Limits Ability to
Control Spending (GAO/HEHS-94-42, Apr.  28, 1994). 


*** End of document. ***