Improper Medicare Payments

Author : Kay Daly
Publisher : DIANE Publishing
ISBN 13 : 9780756708962
Total Pages : 54 pages
Book Rating : 4.66/5 ( download)

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Download or read book Medicare Improper Payments written by Kay Daly and published by DIANE Publishing. This book was released on 2001-04 with total page 54 pages. Available in PDF, EPUB and Kindle. Book excerpt: Reviews the Health Care Fin Admin's. (HCFA) efforts to enhance the measurement of improper payments in the Medicare fee-for-service program. Identifies structural problems that exist in the Medicare claims processing system which contribute to vulnerabilities resulting in erroneous Medicare payments. Focuses on: what HCFA proposals have been designed or initiated to measure Medicare improper payments; & the status of these proposals & initiatives & how they will enhance HCFA's ability to comprehensively measure improper Medicare payments & the frequency of kickbacks, false claims, & other inappropriate provider practices. Tables.

Author : United States. Congress. House. Committee on Oversight and Government Reform. Subcommittee on Government Organization, Efficiency, and Financial Management
Publisher :
ISBN 13 :
Total Pages : 88 pages
Book Rating : 4.32/5 ( download)

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Download or read book Improper Medicare Payments written by United States. Congress. House. Committee on Oversight and Government Reform. Subcommittee on Government Organization, Efficiency, and Financial Management and published by . This book was released on 2012 with total page 88 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Author : James C. Cosgrove
Publisher : DIANE Publishing
ISBN 13 : 1437916139
Total Pages : 53 pages
Book Rating : 4.33/5 ( download)

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Download or read book Medicare written by James C. Cosgrove and published by DIANE Publishing. This book was released on 2009-09 with total page 53 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare spending on home health totaled $12.9 billion in 2006, up 44% from 2002. Concerns have been raised that improper payments from practices indicating fraud and abuse may have contributed to Medicare home health spending and utilization. This report examines the growth in Medicare home health spending and utilization and the benefit's vulnerability to improper payments. The report focused on states with the highest growth in Medicare home health spending or utilization; fraudulent and abusive practices contributing to recent spending and utilization; and administrative issues that make it vulnerable to improper payments. Includes recommendations. Charts and tables.

Author :
Publisher : DIANE Publishing
ISBN 13 : 142897217X
Total Pages : 34 pages
Book Rating : 4.79/5 ( download)

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Download or read book Medicare improper payments challenges for measuring potential fraud and abuse remain despite planned enhancements written by and published by DIANE Publishing. This book was released on with total page 34 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Author : U S Government Accountability Office (G
Publisher : BiblioGov
ISBN 13 : 9781289001346
Total Pages : 38 pages
Book Rating : 4.40/5 ( download)

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Download or read book Medicare Improper Payments written by U S Government Accountability Office (G and published by BiblioGov. This book was released on 2013-06 with total page 38 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pursuant to a congressional request, GAO discussed the Health Care Financing Administration's (HCFA) efforts to improve the measurement of improper payments in the Medicare fee-for-service program. GAO noted that: (1) because it was not intended to include procedures designed specifically to identify all types of potential fraudulent and abusive activity, the current methodology does not provide an estimate of the full extent of improper Medicare fee-for-service payments; (2) HCFA has initiated three projects designed to further its measurement efforts which offer some promise for determining the extent of improper payments attributable to potential fraud and abuse; (3) based on careful evaluation of their effectiveness, performing additional potential fraud identification techniques as part of its efforts to measure improper payments could assist HCFA in arriving at a more comprehensive measurement and, ultimately, develop cost-effective internal controls to combat improper payments; and (4) however, no set of techniques, no matter how extensive, can be expected to measure all potential fraud and abuse.

Author : United States. General Accounting Office. Accounting and Information Management Division
Publisher :
ISBN 13 :
Total Pages : 2 pages
Book Rating : 4.80/5 ( download)

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Download or read book Medicare written by United States. General Accounting Office. Accounting and Information Management Division and published by . This book was released on 2000 with total page 2 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Author : U.s. Government Accountability Office
Publisher : Createspace Independent Publishing Platform
ISBN 13 : 9781973955801
Total Pages : 24 pages
Book Rating : 4.06/5 ( download)

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Download or read book Medicare written by U.s. Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-07-26 with total page 24 pages. Available in PDF, EPUB and Kindle. Book excerpt: " Due to its size, complexity, and susceptibility to mismanagement and improper payments, GAO has designated Medicare as a high-risk program. In 2013, Medicare financed health care services for approximately 51 million individuals at a cost of about $604 billion, and reported an estimated $50 billion in improper payments-payments that either were made in an incorrect amount or should not have been made at all. Most of these improper payments were made through the Medicare FFS program, which pays providers based on claims and uses contractors to pay the claims and ensure program integrity. This statement focuses on the progress made and steps still to be taken by CMS to improve improper payment prevention and recoupment efforts in the Medicare FFS program. This statement is based on relevant GAO products and recommendations issued from 2007 through 2014 using a variety of methodologies. GAO also updated information by examining public documents and, in April 2014, GAO received updated information from CMS on its actions related to laws and regulations discussed in this statement. What GAO Found The Centers for Medicare & Medicaid Services (CMS), the agency within the Department of Health and Human Services (HHS) that oversees Medicare, has made progress improving improper payment prevention and recoupment efforts in the Medicare fee-for-service (FFS) program, but further actions are needed. Provider enrollment. CMS has implemented certain provider enrollment screening procedures authorized by the Patient Protection and Affordable Care Act (PPACA) that address past weaknesses identified by GAO and others. The agency has also put in place other measures intended to strengthen existing procedures, but could do more to improve provider enrollment screening and ultimately reduce improper payments. For example, CMS has hired contractors to determine whether providers and suppliers have valid licenses, meet certain Medicare standards, and are at legitimate locations. CMS also recently contracted for fingerprint-based criminal history checks of providers and suppliers it has identified as high-risk. However, CMS has not implemented other screening actions authorized by PPACA that could further strengthen provider enrollment. Prepayment controls. In response to GAO's prior recommendations, CMS has taken steps to improve the development of certain prepayment edits-prepayment controls used to deny Medicare claims that should not be paid; however, important actions that could further prevent improper payments have not yet been implemented. For example, CMS has implemented an automated edit to identify services billed in medically unlikely amounts, but has not implemented a GAO recommendation to examine certain edits to determine whether they should be revised to reflect more restrictive payment limits. GAO has found that wider use of prepayment edits could help prevent improper payments and generate savings for Medicare. Postpayment claims reviews. Postpayment claims reviews help CMS identify and recoup improper payments. Medicare uses a variety of contractors to conduct such reviews, which generally involve reviewing a provider's documentation to ensure that the service was billed properly and was covered, reasonable, and necessary. GAO has found that differing requirements for the various contractors may reduce the efficiency and effectiveness of such reviews. To improve these reviews, GAO has previously recommended CMS examine ways to make the contractor requirements more consistent.

Author : United States Government Accountability Office
Publisher : Createspace Independent Publishing Platform
ISBN 13 : 9781985255357
Total Pages : 56 pages
Book Rating : 4.59/5 ( download)

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Download or read book Medicare Improper Payments written by United States Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2018-02-10 with total page 56 pages. Available in PDF, EPUB and Kindle. Book excerpt: AIMD/OSI-00-281 Medicare Improper Payments: While Enhancements Hold Promise for Measuring Potential Fraud and Abuse, Challenges Remain

Author : United States Government Accountability Office
Publisher : Createspace Independent Publishing Platform
ISBN 13 : 9781985255326
Total Pages : 34 pages
Book Rating : 4.24/5 ( download)

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Download or read book Medicare Improper Payments written by United States Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2018-02-10 with total page 34 pages. Available in PDF, EPUB and Kindle. Book excerpt: T-AIMD/OSI-00-251 Medicare Improper Payments: Challenges for Measuring Potential Fraud and Abuse Remain Despite Planned Enhancements

Author : United States. General Accounting Office
Publisher :
ISBN 13 :
Total Pages : 50 pages
Book Rating : 4.14/5 ( download)

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Download or read book Medicare Improper Payments written by United States. General Accounting Office and published by . This book was released on 2000 with total page 50 pages. Available in PDF, EPUB and Kindle. Book excerpt: