All Articles In 'Tag Archives: 'GAO''
Prescription Drugs: A Look at Pharmacy Services Administrative Organizations
Independent pharmacies play a central role in the U.S. prescription drug market, distributing almost one in five drugs sold in the country. But small pharmacies often do not have the resources to handle the administrative burden [...]
Medicare-Medicaid Dual Eligibles: Consumer Protection Requirements Vary by Program and State
Enrollees in both Medicare and Medicaid, called dual eligibles, are the most expensive and vulnerable group of beneficiaries. More than 40 percent of dual eligibles have severe cognitive disabilities, are likely to have severe physical disabilities, [...]
Congressional Liaison Offices of Federal Health Agencies
Federal health agencies, like the Centers for Medicare and Medicaid Services and the Food and Drug Administration, must maintain large congressional liaison offices. Below is a listing of congressional liaison offices of federal health agencies, including CMS, [...]
Medicare and Medicaid Fraud: Breakdown of Types of Healthcare Provider Fraud and Abuse Cases
Fraud and abuse are common and persistent problems for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Combined federal and state spending now exceeds $1 trillion, with fraud and abuse likely costing taxpayers well over $100 billion [...]
Medicaid Providers with Unpaid Federal Taxes: $800 Million Unpaid in Florida, New York, and Texas
The Government Accountability Office (GAO) recommended in a recent report that the Internal Revenue Service (IRS) step up its enforcement of tax collections for Medicaid providers, finding that providers in three selected states owed nearly $800 [...]
Medicaid Expansion: States Report Limited, Poor Federal Guidance to Implement ACA Medicaid Expansion
So far, federal guidance has fallen short of what states need to implement the Affordable Care Act’s Medicaid expansion, according to a recent report by the Government Accountability Office (GAO). State officials questioned for the report said [...]
Medical Devices and the FDA: FDA Taking Longer to Approve New Medical Devices for U.S. Market
The Food and Drug Administration (FDA) reviews the safety and effectiveness of new medical devices sold in the United States, and The Medical Device User Fee and Modernization Act of 2002 (MDUFMA) authorizes FDA to collect [...]
Comparative Effectiveness Research: How Agency for Healthcare Research and Quality Spent $474 Million in ARRA Funds
As part of the $1.1 billion provided to the Department of Health and Human Services (HHS) earmarked for comparative effectiveness research (CER) under the American Recovery and Reinvestment Act (ARRA or Recovery Act) of 2009, $474 [...]
Medicare Advantage Risk Adjustment: GAO Recommends CMS Risk Score Adjustments for Diagnostic Coding
Through the years, the Centers for Medicare and Medicaid Services (CMS) has changed its payment adjustment method for Medicare Advantage (MA) plans. These adjustments are made based on a calculated risk score per beneficiary, which should be consistent [...]
Medicare Secondary Payer: Options for Improving Medicare Payment Recoveries from Individual, Non-Group Health Plans
The Centers for Medicare and Medicaid Services (CMS), charged with protecting Medicare’s fiscal integrity, works to recover payments made by Medicare that are the responsibility of non-group health plans. While CMS has not always been aware [...]
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