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 2000-03-09 monographic deposited born digital 12 p. GA 1.13:T-HEHS-00-74 https://www.govinfo.gov/app/details/GAOREPORTS-T-HEHS-00-74 P0b002ee18039897f f:he00074t DGPO 2010-08-12 2011-03-28 GAOREPORTS-T-HEHS-00-74 machine generated eng fdlp REPORT GAOREPORTS-T-HEHS-00-74 T-HEHS-00-74 Health care programs Health insurance Erroneous payments Internal controls Medical information systems Health services administration Program abuses Fraud Managed health care Contract oversight Medicare Choice Program Medicare Program HCFA Medicare Transaction System Supplementary Medical Insurance Trust Fund Hospital Insurance Trust Fund Testimony HEHS Pursuant to a congressional request, GAO discussed the Health Care Financing Administration's (HCFA) efforts to control improper payments in the Medicare program, focusing on the ongoing and emerging challenges HCFA faces in safeguarding Medicare payments.<p/>GAO noted that: (1) major information gaps exist in the Medicare program--in both traditional Medicare and Medicare Choice--that impede HCFA's ability to minimize program losses attributable to improper payments; (2) in traditional Medicare, HCFA does not have a clear picture of the individual or relative performance of Medicare's claims administration contractors, which are responsible for safeguarding the program's fee-for-service payments that totalled about $171 billion in fiscal year 1999; (3) HCFA also lacks sufficient information on newly designed payment systems to determine whether providers have delivered excessive services or stinted on patient care to inappropriately maximize payments; (4) as for Medicare Choice, HCFA similarly lacks the data needed to monitor the appropriateness of payments made to health plans and the services Medicare enrollees receive; (5) owing to a failed attempt in the 1990s to modernize Medicare's multiple information systems, HCFA's current systems remain seriously outmoded; and (6) without effective systems, the agency is not well-positioned to collect and analyze data regarding beneficiaries' use of services--information that is essential to managing the program effectively and safeguarding program payments. https://www.govinfo.gov/content/pkg/GAOREPORTS-T-HEHS-00-74/html/GAOREPORTS-T-HEHS-00-74.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-T-HEHS-00-74/pdf/GAOREPORTS-T-HEHS-00-74.pdf GAO/T-HEHS-00-74 https://www.govinfo.gov/app/details/GAOREPORTS-T-HEHS-00-74 Testimony GAO/T-HEHS-00-74; Medicare: HCFA Faces Challenges to Control Improper; Health care programs Health insurance Erroneous payments Internal controls Medical information systems Health services administration Program abuses Fraud Managed health care Contract oversight Medicare Choice Program Medicare Program HCFA Medicare Transaction System Supplementary Medical Insurance Trust Fund Hospital Insurance Trust Fund