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 1995-08-03 monographic deposited born digital GA 1.13:T-HEHS-95-229 https://www.govinfo.gov/app/details/GAOREPORTS-T-HEHS-95-229 P0b002ee18039131a f:the95229 DGPO 2010-08-12 2011-03-24 GAOREPORTS-T-HEHS-95-229 machine generated eng fdlp REPORT GAOREPORTS-T-HEHS-95-229 T-HEHS-95-229 Medicare programs Health maintenance organizations Beneficiaries Contract monitoring Noncompliance Health care services Quality assurance Appellate procedure Health services administration Florida Testimony HEHS This testimony discusses problems that the Health Care Financing Administration (HCFA) has had monitoring health maintenance organizations (HMO) it contracts with to provide services to Medicare beneficiaries, and ensuring that they comply with Medicare's performance standards. GAO found weaknesses in HCFA's quality assurance monitoring, enforcement measures, and appeal processes. Although HCFA routinely reviews HMO operations for quality, these reviews are generally perfunctory and do not consider the financial risks that HMOs transfer to providers. Moreover, HCFA collects virtually no data on services received through HMOs to enable HCFA to identify providers who may be underserving beneficiaries. In addition, HCFA's HMO oversight has two other major limitations: enforcement actions are weak, and the beneficiary appeal process is slow. HCFA's current regulatory approach to ensuring good HMO performance appears to GAO to lag behind the private sector. https://www.govinfo.gov/content/pkg/GAOREPORTS-T-HEHS-95-229/html/GAOREPORTS-T-HEHS-95-229.htm GAO/T-HEHS-95-229 https://www.govinfo.gov/app/details/GAOREPORTS-T-HEHS-95-229 Testimony GAO/T-HEHS-95-229; Medicare: Increased Federal Oversight of HMO's Could Improve Quality of and Access to Care; Medicare programs Health maintenance organizations Beneficiaries Contract monitoring Noncompliance Health care services Quality assurance Appellate procedure Health services administration Florida