United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1996-01-24 monographic deposited born digital 32 p. GA 1.13:HEHS-96-18 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-96-18 P0b002ee180380e15 f:he96018 DGPO 2010-08-12 2011-03-24 GAOREPORTS-HEHS-96-18 machine generated eng fdlp REPORT GAOREPORTS-HEHS-96-18 HEHS-96-18 Health care programs Fraud Program abuses Erroneous payments Claims processing Nursing homes Long-term care Health care cost control Medical expense claims Billing procedures Medicare Program Letter Report HEHS Pursuant to a congressional request, GAO reviewed allegations of fraud and abuse related to services and supplies provided to nursing facility patients, focusing on: (1) the nature and extent of such fraud and abuse exist; (2) why nursing facility patients are an attractive target for miscreants; and (3) options for reducing fraudulent billing practices.<p/>GAO found that: (1) fraudulent and abusive billing of Medicare is widespread and frequent and a wide variety of providers have been involved in Medicare fraud or abusive billing related to nursing facility patients' care; (2) most fraud and abuse involves billing Medicare for unnecessary or undelivered services and supplies or misrepresenting services to obtain reimbursement; (3) Medicare patients in nursing facilities are attractive fraud targets because of the high volume and concentration of Medicare beneficiaries in nursing facilities, easier access to patients' medical records, billing without confirmation, the lack of sufficient and timely warning flags in Medicare's automated claim processing systems, and inadequate recovery of unwarranted payments; (4) to change its reimbursement method to incorporate the nursing facilities' monitoring of the provision of services and supplies Medicare will need long-term commitment, structural changes, unified billing, and capped payments; and (5) short-term steps to reduce fraud and abusive billing include instituting federal penalties for unauthorized disclosure of patients' medical records and incorporating various early warning controls into Medicare's claim processing systems. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-96-18/html/GAOREPORTS-HEHS-96-18.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-96-18/pdf/GAOREPORTS-HEHS-96-18.pdf GAO/HEHS-96-18 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-96-18 Letter Report GAO/HEHS-96-18; Fraud and Abuse: Providers Target Medicare Patients in Nursing Facilities; Health care programs Fraud Program abuses Erroneous payments Claims processing Nursing homes Long-term care Health care cost control Medical expense claims Billing procedures Medicare Program Title 42 Part 483(l)(4) 42 CFR Part 483(l)(4)