United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Accounting and Information Management Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1995-05-05 monographic deposited born digital GA 1.13:T-AIMD-95-133 https://www.govinfo.gov/app/details/GAOREPORTS-T-AIMD-95-133 P0b002ee1803a3f8a f:tai95133 DGPO 2010-08-12 2011-03-24 GAOREPORTS-T-AIMD-95-133 machine generated eng fdlp REPORT GAOREPORTS-T-AIMD-95-133 T-AIMD-95-133 Medicare programs Program abuses Billing procedures Overpayments Medical expense claims Health care cost control Claims processing Medical information systems Cost effectiveness analysis Application software Physicians Current Procedural Terminology System CHAMPUS Civilian Health and Medical Program of the Uniformed Services Testimony AIMD With an investment of only $20 million in off-the-shelf commercial software, Medicare could save nearly $4 billion over five years by detecting fraudulent claims by physicians--primarily manipulation of billing codes. On the basis of a test in which four commercial firms reprocessed samples of more than 20,000 paid Medicare claims, GAO estimates that the software could have saved $603 million in 1993 and $640 million in 1994. In addition, GAO estimates that because beneficiaries are responsible for about 22 percent of the payment amounts--mainly in the form of deductibles and copayments--Medicare could have saved an additional $134 million in 1993 and $142 million in 1994. The test results indicate that only a small proportion of providers are responsible for most of the abuses: less than 10 percent of providers in the sample had miscoded claims. https://www.govinfo.gov/content/pkg/GAOREPORTS-T-AIMD-95-133/html/GAOREPORTS-T-AIMD-95-133.htm GAO/T-AIMD-95-133 https://www.govinfo.gov/app/details/GAOREPORTS-T-AIMD-95-133 Testimony GAO/T-AIMD-95-133; Medicare Claims Billing Abuse: Commercial Software Could Save Hundreds of Millions Annually; Medicare programs Program abuses Billing procedures Overpayments Medical expense claims Health care cost control Claims processing Medical information systems Cost effectiveness analysis Application software Physicians Current Procedural Terminology System CHAMPUS Civilian Health and Medical Program of the Uniformed Services