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 1998-06-01 monographic deposited born digital 22 p. GA 1.13:HEHS-98-160 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-98-160 P0b002ee1803a57ce f:he98160 DGPO 2010-08-12 2011-03-28 GAOREPORTS-HEHS-98-160 machine generated eng fdlp REPORT GAOREPORTS-HEHS-98-160 HEHS-98-160 Health care programs Erroneous payments Program abuses Fraud Cost control Funds management Internal controls Medical expense claims Service contracts Medicare Trust Fund Medicare Program Medicare Integrity Program Letter Report HEHS Pursuant to a legislative requirement, GAO reviewed: (1) the Health Care Financing Administration's (HCFA) progress in implementing the Medicare Integrity Program; (2) what additional resources and authorities Congress provided to HCFA through the Medicare Integrity Program; (3) how HCFA has made use of these resources and authorities to improve the protection of Medicare funds; and (4) how HCFA plans to use these authorities and resources in the future.<p/>GAO noted that: (1) the Health Insurance Portability and Accountability Act of 1996 (HIPAA) established the Medicare Integrity Program to subsume the program safeguard activities of HCFA and its current claims processing contractors; (2) rather than fund safeguard activities as part of HCFA's annual administrative budget appropriation, HIPAA appropriates safeguard funding for each year beginning in fiscal year (FY) 1997; (3) the Department of Health and Human Services (HHS) proposed this type of funding arrangement in 1994 so that HCFA and its contractors could better plan and manage program safeguard efforts; (4) the Medicare Integrity Program also provides HCFA the authority to contract with specialists in program safeguards, to separate these functions from current claims processing and payment contracts; (5) the new contracts with program safeguard specialists are intended to make important improvements in HCFA's program safeguard efforts; (6) these improvements will make it possible to review all of the claims for a single beneficiary in one place, reduce the number of contractor safeguard units to increase consistency and simplify HCFA's oversight, and better manage the conflicts of interest that develop when Medicare contractors expand into new health care businesses; (7) for FY 1998, HIPAA significantly increased program safeguard funding over the FY 1997 level; (8) although this funding increase for 1998 was assured when HIPAA became law, HCFA did not notify contractors of their funding until one-third of FY 1998 was past; (9) contractors reported that, because of this delayed notification, they delayed plans to increase their program safeguard staff; (10) HCFA is progressing slowly in contracting with safeguard specialists; (11) the first contract, to be awarded by January 1999, will be limited in scope, covering only part of the work envisioned for program safeguard contracts; (12) this first contract will therefore not provide many of the benefits ultimately expected, nor will it reduce HCFA's reliance on its current contractors for program safeguards; and (13) HCFA has no firm plans regarding when it will expand the scope of this contract or award a second safeguard specialist contract. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-98-160/html/GAOREPORTS-HEHS-98-160.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-98-160/pdf/GAOREPORTS-HEHS-98-160.pdf GAO/HEHS-98-160 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-98-160 Letter Report GAO/HEHS-98-160; Medicare: HCFA's Use of Anti-Fraud-and-Abuse Funding and Authorities; Health care programs Erroneous payments Program abuses Fraud Cost control Funds management Internal controls Medical expense claims Service contracts Medicare Trust Fund Medicare Program Medicare Integrity Program