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Medicare: HCFA Faces Challenges to Control Improper Payments

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Report Type Reports and Testimonies
Report Date March 9, 2000
Report No. T-HEHS-00-74
Subject
Summary:

Both the traditional Medicare program and Medicare+Choice contain major information gaps that impede the ability of the Health Care Financing Administration (HCFA) to minimize program losses attributable to improper payments to claims administration contractors. HCFA does not have a clear picture of how the contractors perform with respect to fee-for-service payments, which totaled $171 billion in fiscal year 1999, or the newly designed payment systems. HCFA similarly lacks data to monitor the appropriateness of payments made to Medicare+Choice health plans and the services the enrollees receive. HCFA's systems for collecting and analyzing data on beneficiaries' use of services are seriously outmoded.

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