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 1999-05-28 monographic deposited born digital 42 p. GA 1.13:HEHS-99-39 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-39 P0b002ee18037d1c1 f:he99039 DGPO 2010-08-12 2011-03-28 GAOREPORTS-HEHS-99-39 machine generated eng fdlp REPORT GAOREPORTS-HEHS-99-39 HEHS-99-39 Health maintenance organizations Health care costs Veterans benefits Health care programs Overpayments Data integrity Data collection Federal agency accounting systems Internal controls Retired military personnel DOD TRICARE Program Medicare Program Medicare Choice Program DOD Medical Expense and Performance Reporting System Civilian Health and Medical Program of the Uniformed Services DOD Medicare Subvention Demonstration Program CHAMPUS Letter Report HEHS

Pursuant to a legislative requirement, GAO provided information on the Medicare Subvention Demonstration Program, focusing on the sufficiency of the Department of Defense's (DOD) data systems for: (1) determining DOD's historical level of effort (LOE) and Medicare payments; and (2) managing the demonstration and assessing its cost effects. GAO noted that: (1) portions of DOD's baseline costs may be understated, which could lead to Medicare overpayments if not adjusted; (2) this results from data inaccuracies in areas of DOD's medical cost accounting system such as pay and prescription drugs; (3) these findings show that the DOD cost system problems GAO and others have reported on over the years persist and continue to affect the DOD health care activities that rely on these systems; (4) at the root of the problem is the long-standing lack of DOD and services' oversight as well as a lack of incentives to ensure the data's accuracy, timeliness, and completeness; (5) DOD officials told GAO that DOD is committed to making whatever adjustments are needed to ensure Medicare does not overpay DOD; (6) data problems also make the subvention demonstration more difficult to manage at both the national and local levels; (7) for example, DOD managers do not have sufficiently accurate or timely data to know whether Medicare capitated payments will cover DOD's costs to provide the full range of health care to beneficiaries or to determine whether it is more cost-effective to deliver care in DOD facilities or purchase it from network providers; (8) timely and accurate tracking of cost and utilization data is critical to these decisions, as is the case in other managed care organizations; (9) acting on the problems GAO identified, DOD officials developed a management improvement plan to begin addressing baseline and systematic data weaknesses, and the Health Care Financing Administration (HCFA) plans to hire a contractor to review DOD's data and methodology; (10) in their reviews, these agencies may need to reestimate the baseline using more reliable data or consider alternate ways to determine the baseline; (11) because DOD uses its cost accounting systems for many other health care management purposes beyond the demonstration's needs, such as resource allocation and make versus buy decisions, GAO believes DOD needs to dedicate sufficient management attention and effort to ensure data reliability and accuracy; and (12) DOD established a health care data quality task force to begin addressing the broader system causes of the data problems that GAO and others have continued to identify. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-39/html/GAOREPORTS-HEHS-99-39.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-39/pdf/GAOREPORTS-HEHS-99-39.pdf GAO/HEHS-99-39 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-39 Letter Report GAO/HEHS-99-39; Medicare Subvention Demonstration: DOD Data Limitations; Health maintenance organizations Health care costs Veterans benefits Health care programs Overpayments Data integrity Data collection Federal agency accounting systems Internal controls Retired military personnel DOD TRICARE Program Medicare Program Medicare Choice Program DOD Medical Expense and Performance Reporting System Civilian Health and Medical Program of the Uniformed Services DOD Medicare Subvention Demonstration Program CHAMPUS Title 42 Section 1395ggg 42 U.S.C. 1395ggg Volume 111 Page 251 111 Stat. 251 Public Law 105-33