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 1999-09-09 monographic deposited born digital 20 p. GA 1.13:T-HEHS/OSI-99-174 https://www.govinfo.gov/app/details/GAOREPORTS-T-HEHS-OSI-99-174 P0b002ee1803a49d6 f:h699174t DGPO 2010-08-12 2011-03-23 GAOREPORTS-T-HEHS-OSI-99-174 machine generated eng fdlp REPORT GAOREPORTS-T-HEHS-OSI-99-174 T-HEHS/OSI-99-174 Claims processing Overpayments Fraud Internal controls Contract performance Program abuses Contract oversight Contractor violations Fines (penalties) Health insurance Medicare Program Medicare Contractor Performance Evaluation Program Blue Cross and Blue Shield Insurance Benefit Plan Medicare Fee-for-Service Program Testimony HEHS OSI The Health Care Financing Administration (HCFA) paid its Medicare fee-for-service claims administration contractors $1.6 billion in fiscal year 1998 to serve as the program's first line of defense against inappropriate and fraudulent claims. Since 1993, eight contractors have been convicted of criminal offenses, have been fined, or have entered into civil settlements. Several of their employees engaged in improprieties and covered up poor performance to allow contractors to keep their Medicare business. Improper activities included improperly screening, processing, and paying claims; destroying claims; and failing to properly collect money providers owed Medicare. Contractors also falsified their performance results and tried to deceive HCFA and circumvent its performance reviews. HCFA often failed to detect improper activities because it gave contractors too much advance notice of its oversight visits and record reviews. Weaknesses in HCFA's current oversight might allow the same types of activities to continue undetected. GAO believes that HCFA plans to act on recommendations GAO made in July 1999 regarding its contractor management policy and plans, assessment, evaluation, and oversight. Although this will help improve its management and oversight of the contractors, it will not make Medicare less vulnerable to their abuses. https://www.govinfo.gov/content/pkg/GAOREPORTS-T-HEHS-OSI-99-174/html/GAOREPORTS-T-HEHS-OSI-99-174.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-T-HEHS-OSI-99-174/pdf/GAOREPORTS-T-HEHS-OSI-99-174.pdf GAO/T-HEHS/OSI-99-174 https://www.govinfo.gov/app/details/GAOREPORTS-T-HEHS-OSI-99-174 Testimony GAO/T-HEHS/OSI-99-174; Medicare: HCFA Oversight Allows Contractor Improprieties; Claims processing Overpayments Fraud Internal controls Contract performance Program abuses Contract oversight Contractor violations Fines (penalties) Health insurance Medicare Program Medicare Contractor Performance Evaluation Program Blue Cross and Blue Shield Insurance Benefit Plan Medicare Fee-for-Service Program