GAO continues criticism of HCFA’s fraud efforts
GAO continues criticism of HCFA’s fraud efforts
HCFA’s fraud control measures continue to draw fire from the General Accounting Office. Congress’ watchdog agency has issued yet another report (HEHS-98-215R) that points out weaknesses in Medicare fraud controls by carriers and fiscal intermediaries, which are supposed to get more money under the HIPAA legislation.
"Despite fiscal year 1998 budget increases, contractors we visited have not increased their staff involved in program safeguard activities, such as provider audit and claims reviews," the report notes. In turn, contractors are reluctant to beef up their audit programs because they aren’t sure of how much anti-fraud money they will get from HCFA, says GAO.
HCFA didn’t notify carriers and intermediaries of their FY 1998 funding until four months into the fiscal year, and now "contractors’ staffing for some important program integrity activities is now less than it was before HIPAA," according to the study. Nor has HCFA coordinated audit programs among different carriers, so controls successfully developed by some haven’t been copied by others.
One solution would be an on-line claims processing system. Too bad that HCFA’s planned Medicare Transaction System was scotched because of delays and overruns. Nor will shifting patients to managed care help, because HCFA’s oversight of HMOs has been weak, says GAO.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.