Tag Archives: CMS

Resolving Technical Difficulties with State Health Insurance Marketplaces

Under the Patient Protection and Affordable Care Act, marketplace websites were supposed to let people seamlessly enroll in private health insurance plans and apply for premium subsidies. But these state-based websites and their underlying and related systems were far from … Continue reading

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When Self-Reporting Fails, Fraud Prevails

Nearly 2 million doctors, nurses, medical equipment suppliers, and other health care providers participate in Medicare, according to the Centers for Medicare and Medicaid Services. To get paid for their services to Medicare beneficiaries, providers must first tell CMS about themselves, … Continue reading

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Checking Up on Medicare and Medicaid at 50

Today Medicare and Medicaid turn 50. These landmark programs are the largest sources of health care coverage for millions of older, low-income, and medically needy Americans. Medicare helps provide health care coverage for 54 million aged and disabled individuals, and … Continue reading

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Exploring 19 States’ Medicaid Managed Care Data

As Medicaid spending and enrollment have grown in recent years, states have increasingly turned to managed care as a way to try to save money and improve delivery of medical services. Yet little is known about the number or types … Continue reading

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Podcast on Medicaid Fraud Controls

Through Medicaid, hundreds of thousands of doctors and other health care professionals provide care to tens of millions of beneficiaries—at a cost of $310 billion to the federal government in fiscal year 2014. To help ensure only legitimate providers and … Continue reading

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Podcast on Medicaid Payments to Health Care Providers

Under Medicaid, states pay health care providers and receive federal matching funds for their payments. We have previously found that some states’ excessive Medicaid payments to certain provider institutions shifted costs inappropriately from states to the federal government.

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Podcast on Health Care Price Transparency

As consumers pay for a growing proportion of their health care, they have an increased need for information on cost and quality before receiving care, to help them plan and make informed decisions. Transparency tools from the Centers for Medicare … Continue reading

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Medicare Recommendations for Healthcare Fraud Prevention and Awareness Month

September may be Healthcare Fraud Prevention and Awareness Month, but GAO tracks this issue year round. Because the Medicare program is particularly susceptible to fraud, waste, and abuse, it has been on our High Risk list since we started compiling … Continue reading

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What Exactly Are “Improper Payments”?

Improper payments are always an area of concern for the federal government. These include overpayments, underpayments, payments made to ineligible recipients, or even payments that weren’t properly documented. While fraudulent payments are considered improper, not all improper payments are the … Continue reading

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