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 1999-07-30 monographic deposited born digital 24 p. GA 1.13:HEHS-99-142 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-142 P0b002ee180390a4f f:he99142 DGPO 2010-08-12 2011-03-28 GAOREPORTS-HEHS-99-142 machine generated eng fdlp REPORT GAOREPORTS-HEHS-99-142 HEHS-99-142 Health care programs Managed health care Fraud Program abuses Department of Defense contractors Internal controls Contract oversight DOD TRICARE Program Letter Report HEHS Pursuant to a legislative requirement, GAO reviewed the Department of Defense's (DOD) health care system, focusing on: (1) DOD's estimates of the extent of health care fraud and abuse; (2) DOD's efforts to reduce health care fraud and abuse in civilian settings; and (3) initiatives and incentives that could improve DOD's antifraud efforts.<p/>GAO noted that: (1) it is impossible to precisely quantify the amount lost to health care fraud and abuse given the nature of such activities, but there is general consensus in DOD and the health care industry that fraud and abuse could account for 10 to 20 percent of all health care costs; (2) given TRICARE managed care contract expenditures of $5.7 billion between 1996 and 1998, DOD could have lost over $1 billion to fraud and abuse during this period; (3) in addition to the financial loss, health care fraud and abuse can also adversely affect the quality of care provided and may cause serious harm to patients' health; (4) DOD and its contractors have had limited success in identifying TRICARE fraud and abuse; (5) for example, contractors have identified a negligible number of potential fraud cases; (6) this low level of fraud identification has occurred, in part, because DOD contracts do not require contractors to aggressively identify and prevent fraud and abuse; (7) during this same period, DOD recovered about $14 million in fraudulent payments out of the $5.7 billion spent; (8) to its credit, DOD recognizes the need to reduce its vulnerability to fraud and abuse and has identified a number of revisions it could make to its antifraud policies and requirements; (9) however, it has been slow to implement these policy revisions, which collectively would require contractors to put into place a more aggressive fraud and abuse identification program; (10) once these revisions are implemented, existing contracts can be modified to include specific results-oriented goals and performance measures, thus putting DOD in a better position to evaluate contractors' progress in identifying and reducing fraud and abuse; (11) given the magnitude of potential financial loss and harm to patients' health, it is important that DOD place a high priority on, and establish a concerted strategy for, reining in health care fraud; and (12) DOD's strategic plan for the military health system, prepared in response to the Government Performance and Results Act of 1993, provides an appropriate vehicle for articulating DOD's strategy and establishing how the agency will identify and prevent TRICARE fraud and abuse. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-142/html/GAOREPORTS-HEHS-99-142.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-142/pdf/GAOREPORTS-HEHS-99-142.pdf GAO/HEHS-99-142 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-142 Letter Report GAO/HEHS-99-142; Defense Health Care: Improvements Needed to Reduce; Health care programs Managed health care Fraud Program abuses Department of Defense contractors Internal controls Contract oversight DOD TRICARE Program Public Law 103-62 S. Rept. 105-189