GAO Report on Oversight of Medicaid Payments to Hospitals

The Government Accountability Office (GAO) has released a report entitled “Medicaid: CMS Oversight of Provider Payments Is Hampered by Limited Data and Unclear Policy.”  The report examines how state Medicaid payments to government hospitals compare to those made to private hospitals in selected states (Illinois, New York, and California) and CMS oversight of such payments. Because states receive federal matching funds for their payments to health providers, the GAO observes that states “may have incentives to make excessive Medicaid payments to certain institutional providers such as hospitals operated by local governments.” The GAO notes that its assessment was hampered by inaccurate and incomplete data on payments. For example, the GAO notes that large supplemental payments states often make to hospitals are not reported by the hospital. While some of the available data was inconclusive, the GAO believes that a small number of government hospitals it identified as receiving high payments warrants oversight. With regard to CMS oversight, the GAO observes that CMS has insufficient information on payments, lacks a policy and process for assessing payments to individual providers, and lacks a policy and standard process for determining whether Medicaid payments to individual providers are economical and efficient. The GAO recommends that CMS take steps to ensure states report provider-specific payment data, establish criteria for assessing payments to individual providers, develop a process to identify and review payments to individual providers, and expedite review of the appropriateness of New York's hospital payments. HHS concurred with the recommendations.

GAO Calls for Tighter Reins on Section 1115 Demonstrations

A recent GAO report examined expenditure authorities in “section 1115” demonstrations approved by HHS between June 2012 and October 2013. Section 1115 of the Social Security Act gives HHS broad authority to approve “expenditure authorities” that allow states to receive federal funds for costs that would not otherwise be matchable under Medicaid if the Secretary believes the authorities are likely to promote Medicaid objectives. In FY 2014, section 1115 demonstrations accounted for almost one-third of total Medicaid expenditures. The GAO is concerned, however, that HHS has not issued specific criteria for making such determinations, and HHS approval documents are not always clear as to precisely what approved expenditures are for and how they will promote Medicaid objectives. In the absence of clear criteria and documentation, the GAO warns that “the bases for HHS’s decisions involving tens of billions of Medicaid dollars are not transparent to Congress, states, or the public.” The GAO therefore recommends that HHS issue criteria for assessing whether expenditure authorities are likely to promote Medicaid objectives and document the use of these criteria in HHS’s approvals of demonstrations.

GAO Calls for Changes to Medicare Payments to PPS-Exempt Cancer Hospitals

A recent Government Accountability Office (GAO) report, “Medicare: Payment Methods for Certain Cancer Hospitals Should Be Revised to Promote Efficiency,” examines the Medicare reimbursement methodology for cancer hospitals exempt from the acute inpatient prospective payment systems (PPS). The GAO determined that Medicare payments were substantially higher at PPS-exempt cancer hospitals (PCHs) in 2012 than at PPS teaching hospitals in the same geographic area for beneficiaries with the same diagnoses or services. GAO estimated that PCHs were paid an average of about 42% more for inpatient services and 37% more for outpatient services than a local PPS teaching hospital would have received for a similar patient. According to the GAO, the PCH inpatient and outpatient reimbursement methodologies “provide little incentive for efficiency.” The GAO therefore recommends that Congress consider requiring Medicare to pay PCHs on the same basis as PPS teaching hospitals or otherwise authorize the HHS Secretary to modify how Medicare pays PCHs. 

GAO Calls for Expanded HHS Efforts to Reduce Antipsychotic Drug Use in Community Settings

The Government Accountability Office (GAO) has issued a report examining the extent to which antipsychotic drugs are prescribed for older adults with dementia in nursing homes and other settings. The GAO found that, according to Medicare Part D data, about one-third of older adults with dementia who spent more than 100 days in a nursing home in 2012 were prescribed an antipsychotic, compared to about 14% of Medicare Part D enrollees with dementia living outside of a nursing home were prescribed an antipsychotic that year. While several agencies within HHS have taken steps to address antipsychotic drug use in nursing homes as part of the National Alzheimer's Plan, these efforts have not applied to older adults in other settings, such as assisted living facilities or individuals' homes. The GAO therefore recommends that HHS update its National Alzheimer's Plan to expand outreach and educational efforts to reduce antipsychotic drug use among older adults with dementia residing outside of nursing homes; HHS concurred.  For details, see the full report, “Antipsychotic Drug Use: HHS Has Initiatives to Reduce Use among Older Adults in Nursing Homes, but Should Expand Efforts to Other Settings.” 

GAO Seeks Stronger CMS Measurement of State Medicaid Program Integrity System Effectiveness

Based on a review of 10 state Medicaid Management Information Systems (MMIS) used to process claims and support program integrity efforts, the GAO has concluded that the effectiveness of these systems is not known because CMS does not require states to measure results related to detecting and preventing improper payments. The GAO therefore recommends that CMS require states to measure and report quantifiable benefits of program integrity systems when requesting federal funds; CMS agreed.

GAO Evaluates CMS Activities to Prepare Health Industry for ICD-10 Launch

According to a recent GAO report, CMS has taken numerous steps to prepare industry for the October 1, 2015 transition to ICD-10 codes, such as developing checklists, timelines, and other educational materials and hosting training sessions for Medicare providers. CMS also has monitored covered entity and vendor readiness through stakeholder collaboration meetings, focus group testing, and surveys. With regard to Medicaid, CMS has provided technical assistance to Medicaid agencies, although GAO observes that as of November 2014, not all state Medicaid agencies had started testing their systems’ abilities to accept and adjudicate claims with ICD-10 codes. Stakeholder organizations continue to have concerns about the comprehensiveness of CMS testing and the extent to which entities are using CMS educational materials. The GAO notes that CMS has taken steps to address these concerns by expanding end-to-end testing, promoting awareness of its educational materials, and developing more training options.

Note that CMS announced on February 25, 2015 that Medicare FFS providers, clearinghouses, and billing agencies successfully participated in the first successful ICD-10 end-to-end testing week (from January 26 through February 3, 2015) with all Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor. CMS was able to accommodate all volunteers, which represented a broad cross-section of provider, claim, and submitter types.

GAO Highlights Medicare Program Risks and Recommends Program Integrity Actions

The Government Accountability Office (GAO) has released its latest update to its “High-Risk Series” reports, which again lists Medicare as a high-risk program, in part because of the program’s substantial size and scope, and its wide-ranging effects on beneficiaries, the health care industry, and the U.S. economy. The latest report highlights five areas of particular concern to the GAO: 

  1. Payments and provider incentives in original Medicare (specifically referencing physician feedback reports, physician self-referral policy, high-expenditure Part B drugs, end stage renal disease (ESRD) bundled payments, and low-volume payment adjustments for dialysis facilities);
  2. Medicare Advantage (MA) and other Medicare health plans (including concerns about MA plan payment adjustments and excess payments to Special Needs Plans);
  3. Program design effects on beneficiaries (addressing coordination for dual-eligible beneficiaries, dual-eligible special needs plans, and access to preventive services);
  4. Program management (including implementation of durable medical equipment competitive bidding and oversight of Centers for Medicare & Medicaid Services (CMS) contracts); and
  5. Oversight of patient care and safety (including the use of clinical data registries and oversight of vulnerable Medicare beneficiaries in nursing homes and long-term care hospitals (LTCHs)).

The GAO makes a series of recommendations to Congress and CMS to address program risks. Specifically, GAO recommends that Congress consider directing the HHS Secretary to require providers who self-refer intensity-modulated radiation therapy services to disclose to their patients that they have a financial interest in the service. The GAO also recommends that Congress better align Medicare beneficiary cost-sharing requirements with U.S. Preventive Task Force recommendations.

Specific recommendations for CMS include:

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GAO Examines Geographic Variation in Private Payer Spending on High-Cost Procedures

On January 28, 2015, the Government Accountability Office (GAO) released a report entitled “Private Health Insurance: Geographic Variation in Spending for Certain High-Cost Procedures Driven by Inpatient Prices.” In the report, the GAO examines: (1) how spending per episode of care for certain high-cost procedures varies across geographic areas for private payers, and (2) how the mix of service types, and the volume, intensity, and price of services contribute to variation in episode spending across geographic areas for private payers. Specifically, using a large private sector claims database, GAO examined 2009 and 2010 spending by metropolitan statistical areas (MSA) for episodes of care for three commonly performed inpatient procedures -- coronary stent placement, laparoscopic appendectomy, and total hip replacement. The GAO examined spending by service category: hospital inpatient, hospital outpatient, post-discharge, professional, and ancillary services. For inpatient and professional services, GAO examined the volume, intensity, and price of services.

According to the GAO, its investigation found that spending for an episode of care in the private sector varied across MSAs for the three procedures, even after GAO adjusted for geographic differences in the cost of doing business and differences in enrollee demographics and health status. MSAs in the highest-spending quintile had average adjusted episode spending that was 74% to 94% higher than MSAs in the lowest-spending quintile, depending on the procedure. The price of the initial hospital inpatient admission was the key driver of differences in episode spending in high- and low-spending MSAs. Professional services (office visits and other services provided by a physician or other health professional) were the second largest contributor to geographic differences, but accounted for only 7% or less of the difference in total episode spending between MSAs in the lowest- and highest-spending quintiles. The report does not include recommendations, and GAO notes that its findings may not be generalizable to all private insurers due to data limitations. 

GAO Examines Hospital Reporting of GPO Fees

The GAO has issued a report, "Group Purchasing Organizations: Funding Structure has Potential Implications for Medicare Costs,” that examines the effects of group purchasing organization (GPO) contracting practices and their funding structure. The five GPOs in GAO’s review reported being predominately funded by administrative fees collected from vendors (totaling $2.3 billion in 2012), which were almost always based on a percentage of the purchase price of products obtained through GPO contracts. The five GPOs reported that nearly 70% of these fees were passed on to GPO customers or owners. The GAO points out that literature and expert views on the effects of this funding structure vary. To the extent that the vendor fee-based funding structure affects prices for medical products and services, Medicare payment rates could be affected since hospital cost reports impact annual payment updates. The GAO notes that repealing the safe harbor that allows administrative fees could eliminate the potential effects of the GPO funding structure on Medicare payment rates, but the agency cited concerns that this could be disruptive to the health care supply chain at least in the short term. The GAO recommends that the HHS Secretary determine whether hospitals are appropriately reporting administrative fee revenues on their Medicare cost reports and take steps to address any under-reporting that may be found.

GAO Catalogues CMS Medicare Part D Program Integrity Practices

A recent GAO report, “Medicare Program Integrity: CMS Pursues Many Practices to Address Prescription Drug Fraud, Waste, and Abuse,” lists current and planned CMS prevention, detection, and monitoring policies intended to promote program integrity in the Medicare Part D prescription drug program. The report does not include new recommendations.

GAO Analyzes Medicare DMEPOS Competitive Bidding Results

The GAO has released a report entitled “Medicare: Bidding Results from CMS’s Durable Medical Equipment Competitive Bidding Program,” which includes a wide variety of data on level of savings in each bidding round, characteristics of suppliers, reasons for disqualification of bids, and related data. The report does not include recommendations.

GAO Calls on CMS to Improve Transparency of Health Care Cost, Quality Data

The GAO recently examined the effectiveness of health cost and quality transparency tools available to consumers, including two private consumer health cost/quality websites and CMS “Compare” databases. The GAO determined that the CMS tools — Nursing Home Compare, Dialysis Facility Compare, Home Health Compare, Hospital Compare and Physician Compare — are limited in their provision of relevant and understandable consumer cost and quality information. For instance, the sites do not allow consumers to combine cost and quality information to assess the value of health care services or anticipate costs, and the sites lack clarity in how information is presented to consumers. The GAO also charges that CMS's process for developing and selecting cost and quality measures included in the Compare sites “has been heavily influenced by the concerns of providers rather than consumers.” With regard to the private sites, the GAO notes that the private consumer sites suggest a wide range of provider costs for the same service in the same geographic area, regardless of quality. The GAO recommends that CMS take steps to improve the information in its transparency tools and develop procedures and metrics to ensure that tools address consumers' needs. For instance, the GAO suggests that the CMS Compare websites include, to the extent feasible, estimated out-of-pocket costs for Medicare beneficiaries for common treatments that can be planned in advance, and allow consumers to customize information presented.  For more information, see the full report, “Health Care Transparency: Actions Needed to Improve Cost and Quality Information for Consumers.”

GAO Calls for Improvements to Information Security and Privacy Controls

The Government Accountability Office (GAO) has assessed the effectiveness of CMS controls intended to protect the security and privacy of the information and information technology (IT) systems used to support The GAO determined that while CMS has taken steps to protect security and privacy, “weaknesses remain both in the processes used for managing information security and privacy as well as the technical implementation of IT security controls.” The GAO warns that until such weaknesses are fully addressed, risks remain with regard to unauthorized access, disclosure, or modification of the information collected and maintained by and related systems, along with potential disruption of services. The GAO made a series of recommendations to implement security and privacy management controls related to For details, see the full report, “ Actions Needed to Address Weaknesses in Information Security and Privacy Controls.”

GAO Assesses Accuracy of Medicare Advantage Encounter Data

A new GAO report reviews CMS’s collection of Medicare Advantage (MA) encounter data, which includes detailed information on services and items furnished to enrollees. CMS plans to use MA encounter data in addition to current diagnosis data to risk adjust capitated payments to MA organizations in 2015. The GAO determined that CMS has not yet developed requirements for completeness and accuracy of the encounter data, nor has it performed statistical analyses that could detect complex data validity issues. The GAO recommends that CMS establish specific plans for using MA encounter data and thoroughly assess data completeness and accuracy before using the data to risk adjust payments or for other purposes.

GAO Calls for Improvements to Medicare Contractor Postpayment Review Process

The Government Accountability Office (GAO) has issued a report entitled “Medicare Program Integrity: Increased Oversight and Guidance Could Improve Effectiveness and Efficiency of Postpayment Claims Reviews."  In the report, the GAO assesses CMS policies and procedures to prevent certain Medicare contractors (Medicare Administrative Contractors, Zone Program Integrity Contractors, Recovery Auditors, and the Comprehensive Error Rate Testing contractor) from conducting duplicative postpayment claims reviews. According to the GAO, while CMS has taken steps to avoid duplicative reviews, the agency “neither has reliable data nor provides sufficient oversight and guidance to measure and fully prevent duplication.” Since ineffective requirements and lack of oversight in this area create “an unnecessary administrative and financial burden for Medicare-participating providers and the Medicare program,” the GAO recommends that CMS provide additional oversight and guidance regarding contractor claims review data collection, duplicative reviews, and contractor correspondence with providers.

OIG, GAO Reports Focus on Operations

The OIG has issued two reports on implementation of the ACA health insurance “Marketplaces.” The first report, “Marketplaces Faced Early Challenges Resolving Inconsistencies with Applicant Data,” looked at the extent to which the federal and state health insurance marketplaces ensured the accuracy of information submitted by insurance applicants, including information related to eligibility for premium tax credits and cost sharing reductions. According to the OIG, marketplaces were unable to resolve most data inconsistencies, particularly involving citizenship and income information (although the OIG cautions that inconsistencies do not necessarily indicate that incorrect information was provided or that financial assistance is inappropriate). The report recommends additional planning and oversight to resolve inconsistencies.

A related OIG report questions the effectiveness of internal controls implemented by the federal, California, and Connecticut marketplaces in ensuring that individuals were enrolled in qualified health plans (QHPs) according to federal requirements. In particular, the OIG identified deficiencies in internal controls that could limit the marketplaces’ ability to prevent the use of inaccurate or fraudulent information when determining applicant’s eligibility for enrollment in a QHP.  The OIG recommended steps to verify applicant data, determine enrollment and cost sharing assistance eligibility, and maintain and update enrollment data. 

Finally, the GAO released a report that concentrates on contractor performance related to the portal. The GAO points cost increases and delayed system functionality for the federally facilitated marketplace that resulted from CMS’s lack of effective planning, changing requirements and oversight gaps. GAO recommends that CMS take immediate steps to address contract costs, acquisition strategies, and use of oversight tools. In its response to the report, CMS discussed improvements it was making in the management of the Marketplace (including a stronger CMS management structure, an improved structure of Marketplace contracts, and a strengthened acquisition workforce). CMS expressed confidence that “its contractors will deliver the needed capabilities for the 2015 open enrollment period in a timely and cost-efficient manner.”

GAO Highlights Differences in Federal Program Drug Prices

The Government Accountability Office (GAO) has released data comparing retail prescription drug prices paid by the Department of Defense (DOD), Medicaid, and Medicare Part D for a sample of 78 high-utilization/high-expenditure drugs. In general, the GAO determined that Medicaid paid the lowest average net prices for both brand-name and generic drugs in the sample based on data for the third quarter of 2010. For the entire sample, Medicare Part D paid an estimated 32% higher average net price than Medicaid, while DOD paid 60% more than Medicaid (although Medicare Part D paid more for brand-name drugs than did DOD). Key factors affecting net prices paid by each program included the amount of any post-purchase price adjustments (e.g., refunds, rebates, or price concessions received by each program from drug manufacturers), which equaled approximately 15% of the gross price for Medicare Part D, 31% for DOD, and almost 53% for Medicaid across the entire sample.

GAO Assesses Trends in Medicare Physical Therapy Self-Referrals

The GAO recently examined “self-referral” for outpatient physical therapy (PT) services, which the GAO defines as a provider referring patients to entities in which the provider or the provider's family members have a financial interest. According to the GAO, non-self-referred PT services per 1,000 Medicare FFS beneficiaries increased by 41% from 2004 to 2010, while the number of self-referred PT was generally flat. Expenditures associated with non-self-referred PT services also grew at a higher rate than for self-referred services. The GAO observed that these findings differ from its prior reviews of self-referrals involving advanced imaging, anatomic pathology, and intensity-modulated radiation therapy, in which the GAO found that self-referred services and expenditures grew faster than non-self-referred services and expenditures. The GAO suggests that a potential reason for this difference is that non-self-referred PT services can be performed by providers who can directly influence the amount, duration, and frequency of PT services through the Medicare written plan of care, whereas radiologists, for example, generally do not have the discretion to order more imaging services or more intense imaging procedures.

In addition, the GAO found that the relationship between provider self-referral status and PT referral patterns was mixed, and varied on the basis of referring provider specialty, Medicare beneficiary practice size, and geography. Self-referring providers in the three specialties that GAO examined (family practice, internal medicine, and orthopedic surgery) generally referred more beneficiaries for PT services on average than non-self-referring providers, but ordered fewer PT services per beneficiary compared to non-self-referring providers. The GAO also found that PT service referrals in the year a provider began to self-refer increased at a higher rate relative to non-self-referring providers of the same specialty.

In the report, “Medicare Physical Therapy: Self-Referring Providers Generally Referred More Beneficiaries but Fewer Services per Beneficiary,” the GAO concluded that regardless of referral patterns, the substantial growth in PT services raises concerns about costs for Medicare and beneficiaries. The GAO suggests that CMS’s initiative to collect additional information on beneficiary functional status on all PT claims may help CMS better assess the appropriateness of PT treatment provided by both self-referring and non-self-referring providers.

GAO Reviews Financial Characteristics of Applicants for Medicaid Nursing Home Coverage

The GAO has issued a report entitled “Medicaid: Financial Characteristics of Approved Applicants and Methods Used to Reduce Assets to Qualify for Nursing Home Coverage.”  The report highlights ways applicants in Florida, New York, and South Carolina reduce their countable assets to qualify for Medicaid nursing home coverage, including (1) spending countable resources on goods and services that are not countable towards financial eligibility, such as prepaid funeral arrangements; (2) converting countable resources into noncountable resources that generate an income stream for the applicant (e.g., an annuity or promissory note); (3) giving away countable assets as a gift to another individual (which could lead to a penalty period that delays Medicaid nursing home coverage); and (4) for married applicants, increasing the amount of assets a spouse remaining in the community can retain (e.g., through the purchase of an annuity). The report does not include recommendations.

GAO Calls for Greater Medicaid Managed Care Program Integrity Efforts

A recent GAO report, “Medicaid Program Integrity: Increased Oversight Needed to Ensure Integrity of Growing Managed Care Expenditures," identified gaps in both state and federal Medicaid managed care program integrity efforts. For instance, based on a review of Medicaid activities in seven states, the GAO found that five state program integrity units and four Medicaid Fraud Control Units focused on Medicaid FFS claims and do not closely examine Medicaid managed care activities. Likewise, the GAO concluded that federal entities have taken few steps to address Medicaid managed care program integrity. As a result, federal and state entities may not be able to ensure that managed care organizations are taking appropriate actions to identify, prevent, or discourage improper payments. Given the expanding role of Medicaid managed care, inadequate managed care program integrity efforts “will leave a growing portion of federal Medicaid dollars vulnerable to improper payments.” The GAO therefore recommended that CMS: require states to audit payments to and by managed care organizations; update its guidance on Medicaid managed care program integrity; and provide states additional support for managed care oversight, such as audit assistance from existing contractors.

Older Entries

April 28, 2014 — GAO Offers Recommendations for Improvements to CMS Physician Feedback Efforts

April 22, 2014 — GAO Examines Impact of Advanced Diagnostic Imaging Accreditation on Medicare Beneficiary Access

April 8, 2014 — OIG, GAO Reports Examine Round 1 Rebid of the Medicare DMEPOS Competitive Bidding Program

February 14, 2014 — GAO Urges CMS to Finalize ACA Medicaid Drug Pricing Reforms

February 13, 2014 — House Panel, GAO Examine Drug Shortages

January 30, 2014 — GAO Report Confirms Insurance Coverage Prior to Medicare Linked to Better Health, Lower Program Spending

January 7, 2014 — GAO Examines Effectiveness of ZPIC Program Integrity Efforts

October 30, 2013 — GAO Ties Medicare Supplemental Coverage to Higher Health Spending

October 30, 2013 — GAO Reports Jump in Medicare EHR Payments

September 16, 2013 — GAO Examines Self-Referral of Anatomic Pathology, IMRT Services

June 27, 2013 — GAO Reviews Status of ACA Insurance Exchange Development

June 26, 2013 — GAO Highlights Gaps in Medicare Imaging Accreditation Framework

June 11, 2013 — GAO Assesses State Efforts to Establish ACA Insurance Exchanges

June 11, 2013 — GAO Compares DOD and VA Drug Purchase Prices

March 13, 2013 — GAO Report Targets MA Risk Score Adjustment Formula

March 13, 2013 — GAO Faults Low-Volume Adjustment Formula for Dialysis Facilities

March 12, 2013 — GAO Releases Data on Pharmacy Services Administrative Organizations

January 30, 2013 — GAO Offers Recommendations for Medicare Physician Value Modifier Program

January 14, 2013 — GAO Calls for Greater Transparency/Accountability for Medicaid Supplemental Payments

January 14, 2013 — GAO Examines Consumer Protections for Medicare/Medicaid Dual Eligibles

December 19, 2012 — GAO Calls for Improvements in Use of Medicare Prepayment Edits

December 19, 2012 — GAO Reviews Effectiveness of Medicaid Program Integrity Efforts

December 19, 2012 — GAO Examines Characteristics of Providers Receiving Medicaid EHR Incentive Payments

December 19, 2012 — GAO Examines Medicare Dialysis Reimbursement

December 17, 2012 — OIG Releases 2012 Compendium of Unimplemented Recommendations

November 29, 2012 — GAO Assesses CMS Fraud Prevention System Implementation

November 16, 2012 — GAO Releases Data on High-Expenditure Medicare Part B Drugs

November 13, 2012 — GAO Report Examines Medicare Costs From Self-Referrals of Advanced Imaging Services

October 30, 2012 — GAO Finds Part D Coverage Gap Discount Program Did Not Spur Increased Drug Prices

October 16, 2012 — GAO Spotlights Top Provider Types for Criminal/Civil Health Fraud

October 16, 2012 — GAO Flags Concerns about Implantable Medical Device Information Security

October 15, 2012 — GAO Highlights Increasing Medicare Ambulance Provider Costs

September 27, 2012 — GAO Reviews Medicare Special Needs Plans for Dual-Eligible Beneficiaries

September 27, 2012 — GAO Information on States' Use of Medicaid Managed Care

September 5, 2012 — GAO Report Focuses on Medicaid Supplemental Payments

September 5, 2012 — GAO Examines State Medicaid LTC Eligibility Information

August 17, 2012 — GAO Reviews States' Implementation of ACA Medicaid Provisions

August 17, 2012 — GAO Examines Unsafe Injection Practices in Ambulatory Care Settings

June 27, 2012 — GAO Examines HHS Action on Privacy and Security of Prescription Drug Data

June 27, 2012 — OIG, GAO Review Medicaid HCBS Programs

June 18, 2012 — Medicare Trends in Implantable Medical Device (IMD) Procedures

May 14, 2012 — GAO Reviews Medicare Provider/Supplier Screening Efforts

May 14, 2012 — GAO Offers Recommendations for EHR Program Safeguards

May 14, 2012 — GAO Report on Impact of Fraud and Abuse Laws on Medicare Financial Incentive Programs

May 14, 2012 — GAO Calls on CMS to Cancel MA Quality Bonus Payment Demonstration

May 14, 2012 — GAO Reviews Oversight of Group Purchasing Organizations (GPOs)

April 23, 2012 — GAO Summarizes Stakeholder Views on Health Care Provider Antitrust Policy

April 23, 2012 — GAO Examines FDA Device Review Process

April 2, 2012 — GAO Examines CMS Nursing Home Quality Rating System

March 14, 2012 — GAO Examines Nursing Home Quality Survey Implementation

March 14, 2012 — GAO Reviews Research on Generic Drug Savings

February 13, 2012 — GAO Focuses on Medicare Advantage (MA) Risk Scores

February 13, 2012 — GAO Examines Price Transparency for Implantable Medical Devices

January 25, 2012 — GAO Examines Prescription Pain Reliever Abuse

January 5, 2012 — GAO Report on Pediatric Medical Devices

December 13, 2011 — GAO Examines Trends in Medicare Advantage Program

November 14, 2011 — GAO Presents Framework for Medicaid Funding Formula Revisions

October 28, 2011 — GAO Highlights Lack of Meaningful Health Care Pricing Information for Consumers

October 28, 2011 — GAO Report Examines CMS Oversight of Long-Term Care Hospitals

October 14, 2011 — GAO Examines Part D "Doctor Shopping"

September 29, 2011 — GAO Examines Manufacturer Discounts Under 340B Drug Program

September 29, 2011 — GAO Assesses DEA Prescription Drug Control Efforts

September 1, 2011 — GAO Report Examines Effectiveness of Medicare Integrity Program.

August 16, 2011 — GAO Assesses Challenges with CMS Physician Feedback Program

August 16, 2011 — GAO Examines Information for Policymakers on Health Care Quality/Value

August 16, 2011 — Part D Plan Mid-Year Formulary Changes Reviewed by GAO

August 16, 2011 — New GAO Report on Private Investment (PI) Nursing Homes

August 1, 2011 — GAO Report on Part D Drug Utilization for Low-Income Subsidy Beneficiaries

July 29, 2011 — GAO Listing of Federal ACA Implementation Contract Awards

July 18, 2011 — GAO Examines Potential "Manufacturer-Level" DMEPOS Competitive Bidding.

June 28, 2011 — GAO Issues Report on FDA Oversight of Medical Device Recalls.

June 27, 2011 — GAO Details Recovery Act Comparative Effectiveness Research Grants

June 14, 2011 — GAO Report on FDA Tracking of Pediatric Research

May 13, 2011 — GAO, OIG Reports on Nursing Home Oversight and Care

April 13, 2011 — GAO Examines Ways to Aid State Medicaid Programs During Recessions

March 29, 2011 — GAO and OIG Examine Medicare Part D Issues

March 29, 2011 — Medicare Payment for Oral ESRD Drugs Examined by GAO

March 29, 2011 — GAO Reports on Pricing Trends for Commonly-Used Drugs

March 29, 2011 — New GAO Reports on Private Health Insurance Coverage, Denials

March 7, 2011 — GAO Reports on Duplications in HHS and Other Federal Programs

March 7, 2011 — Inconsistencies in Electronic Prescribing Incentive Programs

February 18, 2011 — GAO Report on Medicare Home Oxygen Payments

February 18, 2011 — GAO Report on Medicare Advantage Bids

December 28, 2010 — GAO Report on Government Fiscal Challenges

December 28, 2010 — ACA Impact on Medicaid Outpatient Drug Pricing

December 28, 2010 — GAO Recommends Enhanced QIO Quality of Care Review Data

November 29, 2010 — GAO Report on Integrated Delivery Systems

October 29, 2010 — GAO Report on Nursing Home Ownership

October 28, 2010 — GAO Issues Two Reports Examining FDA Foreign Inspection Issues

October 15, 2010 — State Use of Enhanced Medicaid Funding Under Recovery Act

October 15, 2010 — Quality Improvement Organizations (QIO) Responses to Beneficiary Complaints

October 15, 2010 — CMS Use of Error Rate Data To Focus on Error-Prone Providers

October 15, 2010 — Changes in Air Ambulance Industry

September 30, 2010 — GAO Report on GPO Services and Ethics Initiatives

September 17, 2010 — GAO Report on Department of Veterans Affairs (VA) Drug Formulary Process

August 31, 2010 — GAO Report on New Drug Approvals Based on Non-Inferiority Trials

August 13, 2010 — Actuarial Soundness of Medicaid Managed Care Rates

June 17, 2010 — GAO Report on Home Infusion Therapy

June 8, 2010 — GAO Report on Medicare Advantage Plan Design

June 8, 2010 — GAO Report on Nursing Home Deficiencies