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GAO Reports by subject "Medical expense claims"

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Date Report No. Title
Date July 27, 1981 Report No. 115918 Title

Health: Black Lung Program and Black Lung Disability Trust Fund

UNITED STATES GENERAL ACCOUNTING WASHINGTON, DC 20548 OFFICE FOR RELEASE ON DELIVERY Expected at 10 a.m. EST Monday, July 27, 1981 115918 STATEMENT OF MORTON E. HENIG, SENIOR ASSOCIATE DIRECTOR HUMAN RESOURCES DIVISION BEFORE THE SUBCOMMITTEE ON OVERSIGHT COMMITTEE ON WAYS AND MEANS UNITED STATES HOUSE OF REPRESENTATIVES ON THE ,"11 .. i BLACK LUNG PROGRAM AND L... AND BLACK LUNG DISABILITY I X..'...
Date May 14, 1981 Report No. 115235 Title

Health: Legislation and Regulations To Address Abuses in the Home Health Care Industry

UNITED STATES GENERAL ACCOUNTING OFFICE WASHINGTON, D.C. 20548 FOR RELEASE ON DELIVERY Expected at 1O:OO a.m. EDT Thursday, May 14, 1981 STATEMENT OF GREGORYJ. AHART, DIRECTOR HUMAN RESOURCES DIVISION BEFORE THE PERMANENTSUBCOMMITTEE ON INVESTIGATIONS COMMITTEE ON GOVERNMENTALAFFAIRS ON THE ADEQUACY OF r LEGISLATT"N AND REGULATIONS $@ADDRESS'i@USES IN THE HOME HEALTH CARE INDUSTRY 3 Mr. Chairman a...
Date April 15, 1981 Report No. HRD-81-75 Title

Health: New Claim Forms and Changes in Administrative Procedures May Increase Improper CHAMPUS Payments

UNITED STATES GENERAL ACCOUNTINGOFFICE WASHINGTON, D.C. 20548 April The Nonarable John H. Moxley III Assistant Secretary of Defense (Health Affairs) Dear Mr. Moxleyt Subject: 15, 1981 New Claim Forms and Changes in Administrative Procedures May Increase Improper CHAMPUS PaymentsT(HRD-81-75) In a March 16, 1979, letter to the Secretary of Defense (HRD-79-58), we reported that internal control proce...
Date Jan. 14, 1981 Report No. HRD-81-33 Title

Health: Processing of Claims Resulting From the Swine Flu Program

B-199297 injury. We found that no criteria exist to objectively assess the-timeliness of swine flu claims processing. However, we identified some claims processing procedures which took a long time. _.I We obtained limited information on the processing of This included lawsuits resulting from the swine flu program. determining Justice's role in swine flu litigation and gathering descriptive data ...
Date Oct. 22, 1980 Report No. HRD-81-12 Title

Health: Reasonable Charge Reductions Under Part B of Medicare

GAO United States General Accounting Office Ufzhlngton. DC 20548 Human Resources Division B-200144 OCTOBER 22,198O The Honorable The Secretary Dear Mrs. Patricia Roberts Harris of Health and Human Services 113625 _. Harris: Charge A easonable %art B of Medicare Reductions Under (HRD-81-12) Subject: J Pursuant to a request from Senator Lawton Chiles, ChairSenate Special Committee on Aging, we exami...
Date Oct. 6, 1980 Report No. B-189553 Title

Government Operations: [Major Leo D. Doyle, et al. v. United States]

GAO United States General Accounting Office Washington, DC 20548 Office of General Ocunsel In Reply Referto: B-189553 October 6, 1980 The Honorable Alice Daniel Assistant Attorney General Civil Division Department of Justice Attention: Dear Ms. Daniel: Louis Davis, Attorney Commercial Litigation Branch Subject: /Maor Leo D. Doyle, et al. v. United States7/ ~~~~~~s7 Mr. Davis of your staff has requ...
Date July 29, 1980 Report No. HRD-80-79 Title

Health: OPM Should Promote Medical Necessity Programs for Federal Employees' Health Insurance

Comptroller General OF THE UNITEDSTATES OPM Should Promote Medical Necessity Programs For Federal Employees’ Health Insurance This is GAO’s third report calling for the Office of Personnel Management to pay more attention to the medical necessity provisions of its Federal Employees Health Benefits program contracts. OPM has been slow to encour. age health insurance plans to use medical ne. ces...
Date April 28, 1980 Report No. 112192 Title

Health: Electronic Data Systems Federal Corporation's Performance as a Medicare Contractor in Illinois

UNITED STATES GENERAL ACCOUNTING WASHINGTON, D.C. 20548 OFFICE . FOR RELEASE ON DELIVERY Expected at 10:00 A.M. April 28, 1980 Monday, Illinois Chicago, STATEMENT OF MICHAEL ZIMMERMAN i~..,,ASSOCIATE DIRECTOZ, HUMAN RESOURCES DIVIS BEFORE THE SUBCOMMITTEE ON* HEALTH HOUSE GAYS AN3 MEANS COMMITTEE ON DATA SYSTEMS PEELPOXMANCE AS Illill II lllllll 1111 112192 Mr. pleased of Chairman to be here Data ...
Date Sept. 24, 1979 Report No. HRD-79-113 Title

Financial Management: Pennsylvania Needs an Automated System To Detect Medicaid Fraud and Abuse

Comptroller General OF THEUNITED STATES Medicaid fraud and abuse can go undetected in Pennsylvania because the State does not have an automated claims processing and information retrieval system. More State funds are needed to complete the planned Medicaid Management Information System to identify potential fraud and abuse. Although HEW approved Federal funds for Pennsylvania’s Medicaid Fraud Co...
Date Sept. 7, 1979 Report No. HRD-79-87 Title

Health: Stronger Management Needed To Improve Employee Organization Health Plans' Payment Practices

OF THE UNITEDSTATES Stronger Management Needed To Improve Employee Organization Health Plans’ Payment Practices / /The Office of Personnel Management has not done an effective job of guiding and overseeing the Employee Organization Plans participating in the Federal Employees Health Benefits program. The Office has allowed the plans to make claim payments without determining whether the claims r...
Date June 29, 1979 Report No. HRD-79-76 Title

Health: More Can Be Done To Achieve Greater Efficiency in Contracting for Medicare Claims Processing

/mPgo _ B)’ THE CO M PTROL ER GENERA L l~~l~~~~~~l~~~~ L r 1 Report To The Congress OF THEUNITEDSTATES - More Can Be Done To Achieve Greater Efficiency In Contracting Medicare Claims Processing This is a comprehensive study of the claims processing system under Medicare. GAO found many opportunities for HEW to improve its administration and is recommending that the Congress and HEW take a number...
Date April 3, 1979 Report No. 120174 Title

Health: Implementation of Reimbursement Procedures for Outpatient Dialysis Treatments Under the End Stage Renal Disease Program of Medicare

- ~EDSTATES GENERAL ACCOUNTING OFFICE DC. 20.548 \ WASHINGTON, HUMAN RESOURCES DIVISION April 3, 1979 Mr. Leonard Schaeffer, Health Care Financing Department of Health, Welfare Dear Mr. Schaeffer: Administrator Administration Education, Ne have recently completed a survey of the implementation of reimbursement procedures for outpatient dialysis treatments under the end stage renal disease program/...
Date March 9, 1979 Report No. 120152 Title

Health: Survey of Medicare Clinics in Florida

* * UWED STATES GENERALACCOUNTIKG REGIONAL 221 COU~TIIAND OFFICE OFFICE srt?z~-r. r-v& ATLANTA, GEORGIA 30303 . E5i. krginia VI. Sqyth ' ' Regional !KMnistrator HeaNn Care Znaxing &?ministration Depwtxent of H&Lth, Education, md Iklfare 101 &'arietta TMer Atlanta, Georgia 30303 Dear Es. sx!yth: >?ergcently ~._- .comleted a survey of"%edicaze Clinics" in ___. _ As you box, thz clinics have a htgh ~...
Date Aug. 31, 1978 Report No. HRD-78-146 Title

Civil Rights: A Plan for Improving the Disability Determination Process by Bringing It Under Complete Federal Management Should Be Developed

N. CcNm PFV I2 I4by L 3LE- a i~ STRmT'IED Not to be rem d ea GOwM ,, Om enxeepte ,S bld S ,by the Otie Aft r@S5JtVf r3le jj s e * enerMal adtapproval . RL >' LP Fi Comptroller General iQF THE UNITED STATES A Plan For Improving The Disability Determination Process By Bringing It Under Complete Federal Management Should Be Developed The F deral disability insurance program rind the Supplemental Secu...
Date Aug. 10, 1978 Report No. 106844 Title

Health: Medicare's Cost Reimbursement Procedures for Home Health Care

Date March 14, 1978 Report No. HRD-78-68 Title

Health: Civil Service Needs To Improve Claims Review Process Under the Federal Employee Health Benefits Program

DOCaUIT? 05118 [807356591 _**s .z/i IEISUo 3/ Civil Servic' Meeds to lmprove Clais sBeviews Rocess ander tk: Federal Employee Health BeNefits Program. 1BD-78-68; 8-164562. March 1i, 1978. 21 PP. Report to Reap. Gladrs soon Spellman* Chairman, louse Comnittee on Post Office and Civil Service: Compessation and employee Benefits Subcommittee; by Blser B. ttaats, Comptroller General. Issue Area: Healt...
Date Jan. 11, 1978 Report No. 104772 Title

Health: Survey of Controls Used by Medicare Carriers To Prevent Duplicate Payments

UNITED STATESGENERAL Acc0u~~iffG WASHINGTON. D.C. 20348 QFFICE . . - . -_.__.- - _ _ _ _ _______ Wi; RdXrf~XT Diriun; Health Care FiaancinK Department of Health, Welfare Admini 5tfi3 tof Administration Education, and - - -- -- -----.--. . .- .____._ -___ -- -- -- ______ _._ Dari Mr. Dcrtonr ICe hsve rectntly completet a survey of Medicare &rriers’ use of prepayment computer edits to prevent dupl...
Date July 27, 1977 Report No. HRD-77-128 Title

Health: Information on Use of Medicare Reimbursement Method to Determine Hospital Payments under the Civilian Health and Medical Program of the Uniformed Services

DOCUMENT RESUME 02850 A20931941 I estrt-d4 Information on Use of Medicare Reimbursement Method to Determine Hospital Payments under the Civilian Health and Medical Program of the Uniformed Services. HRD-77-128; B-133142. Jujy 27, 1977. 3 pp. + 2 appendices (17 pp.). Report to Rep. George H. Mahon, Chairman, House Committee on Appropriations; Sen. John L. McClellan, Chairman, Senate Committee o App...
Date May 2, 1977 Report No. HRD-77-73 Title

Health: Problems in Carrying Out Medicaid Recovery Programs from Third Parties

DCCUHENT BESUME 01948 A1252235] Problems in Carrying Out Medicaid ecovery Prcgrams from Third Parties. HRD-77-73; E-164031(3). May 2, 1977. 26 pp. Report to Secretary, Department of Health, Education, and Welfare; by Morton E. Henig (fcr Gregory J. Ahart, Director. Human Resources and Development Div.). I:sue Area: Health Programs: Compliance With Financing Laws and Regulations (1207); ealth Progr...
Date March 16, 1977 Report No. 102509 Title

Health: Survey of States' Utilization Review Programs for Noninstitutional Services Under Medicaid

6, Mr. Don I* Uortmar: )* AcUng Administrator Health kdmMstratian Department of Health, bnd Uelfam Care Financing -.. _ _ Dear**uortman: .- 3 . - This is to advise you that we have ampleted a survey of States’ utititation review (also called utiTi2atQm control) program5 for non-institutional services under Kedicaid. Suc?m ?-am fpxs on serviceE- provided by phyawlcare intended to sicians, dentist...
Date Jan. 24, 1977 Report No. HRD-77-29 Title

Health: State Audits To Identify Medicaid Overpayments to Nursing Homes

DOCUUENT RESOME 00503 - [A07510421 z EM e 5 State Audits to Identify Medicaid Overpaymente to Nursing Homes B-164031(3); HRD-77-29. January 24, 1977. Released March 4, 1977. 33 pp. + appendices (3 pp.). Report to Sen. Frank Church, Chairman, on Aging' Long-term Care Subcommittee; Senate Special committee by Elmer B. Staats, Comptroller General. Issue Area: Health Programs: Compliance Regulations (...
Date Jan. 14, 1977 Report No. HRD-76-174 Title

Health: More Civil Service Commission Supervision Needed To Control Health Insurance Costs for Federal Employees

DOCUMENT RESUSE 00502 - [A0590985] R Le 5 More Civil Service Commission Supervision n'eeded to Ccontrol Health Insurance Costs for Federal Eployecs. HD-76-174; B-164562. January 14, 1977. Released January 21, 1977. 49 pp. appendices (32 pp.). + Report to Rep. Richard C. White, Chairman, House Committee on Post Office and Civil Service: Retirement and Employee Subcommittee; by Elmer B. Staats, Comp...
Date May 24, 1976 Report No. 089589 Title

Health: Medicaid Program Overbillings Made by New York State

UNITED STATES GENERAL ACCOUNTING OFFICE REGIONAL 26 FEDERAL OFFICE PLAZA 08458’3 NEWYDRK,NEWYORK 10007 Mr. William Toby, Acting Regional Commissioner Social and Rehabilitation Service Region II Department of ImIealth, Education and Welfare 26 Federal Plaza’ New York, Ne\f York 1000.7 Dear bIr, Toby: , During our review of the system for managing spend-down payments which we believe warrants by...
Date March 1, 1976 Report No. MWD-76-87 Title

Health: Comparative Administrative Cost of Processing Medicare Claims

. . *h COMPTROLLER GENERAL WASHINGTON. OF DC. THE UNITED STATES 3 ~---- -i - \ 20348 . B-164031(4) Hot to be releasedm&sZde~: IWESTRfCTEb 2 kcountkg Offke except on the basis .R*@ by the Office of Congressional A:. Mcr;;;.~--~~~~~~~ ^ ! The Honorable Jack Brooks, Chairman Committee .on Government Operations House of Representatives ,’ Dear Mr. Chairman: As you requested on May 12, 1975, we compa...
Date Feb. 2, 1976 Report No. MWD-76-92 Title

Health: Reasonable Charge Reductions and Related Matters Under Part B of Medicare

m i nistration Blue Cross-Blue Shield of Greater New York reduced about two-thirds of the Medicare claims it processed during fiscal year 1974. The reductions were made because charges exceeded reasonable charges which under program regulations are based on charge data 6to 30”months old. Incorrect coding of claims contributed to the reasonable charge reductions. Relatively fevv claims were invol...
Date Jan. 26, 1976 Report No. MWD-76-89 Title

Income Security: Implementation of Section 1903(g) of the Social Security Act by the Department of Health, Education, and Welfare

January 26, 1976 Chairman, Subcommittee and lnvesticjations Committee on IEntcrstate Foreign Commerce House of kpresentatives Dear fdr, Chairman: on Qversigttil; and r,,~ 2, ";9/) f::' , This is ii ,I (,,/I,/~" .\ a$so to confirm ber 18, 1975, Social Security fkpartment of to your letter dated October 31 Y 7975, and iniort!!ation presented orally to hour staff on Decemregardin:! the implerrzntstio...
Date Feb. 20, 1974 Report No. 094592 Title

Budget and Spending: Direct and Indirect Expenditures by Federal Agencies for Prescription Drugs

UNITED STATES GENERAL ACCOUNTING OFFICE Washington, D.C. 20548 For release on delivery expected at 10 a.m. EDT Wednesday, February 20, 1974 STATEMENT OF ELMER B. STAATS, COMPTROLLER GENERAL OF THE UNITED STATES BEFORE THE MONOPOLY SUBCOMMITTEE SELECT COMMITTEE ON SMALL BUSINESS _ I UNITED STATES SENATE on DIRECT AND INDIRECT EXPENDITURES BY FEDERAL AGENCIES FOR PRESCRIPTION DRUGS We are pleased la...
Date June 30, 1971 Report No. 092610 Title

Health: Payments Made by Medicare Carriers for Drugs and Biologicals Furnished to Medicare Beneficiaries

U~TEB SMES GENERAL Accou~mNc I3 C 20548 OFFICE WASHINGTON, TzitLb XV;r$f of tkm So&d. Seemrity Act protides, in pat, Hedicwe coverage of Capugsand biologkals s&U include: that Initial instmctiona 3ssued by SSA in Ju3.y 1966 provided that dmgs and biologhals wwe covered only if thy wema of the type that, could not be self-admmstimd by injection, Vaceinatio~ OP imocu%ations W&~FB covwad if tkay wem ...
Date June 28, 1971 Report No. 092615 Title

Health: Medicare Payments Involving Hospital Based Physicians in Illinois

U:~~TEDSTATES GENERAL AC~‘JU~~TING OFFICE WASHINGTON,‘D C 2X% CIVIL DIVISION JIRM 28, 1971 Dear Mr. Ball: mrtig a recent snrvey of I%dEcas?epayments 3.lwol.ving hospS.tsX-based ghysi.e%a~~ in ZlXU.nois, we noted a situation where cme hospsital mce%w!d, zmd tm others may hmm received, excess5~ part B PehbnPs@ments Ql! '~dfas" which were not acl;jpastedbythe %nte~mtimy~ IB are bre.&nmg this matt...