Medicare Advantage: Continued monitoring and implementing GAO recommendations could improve oversight : testimony before the Subcommittee on Oversight and Investigations, Committee on Energy and Commerce, House of Representatives
- Collection:
- Health Policy and Services Research
- Alternate Title(s):
- Continued monitoring and implementing GAO recommendations could improve oversight: testimony before the Subcommittee on Oversight and Investigations, Committee on Energy and Commerce, House of Representatives
- Contributor(s):
- United States. Government Accountability Office, issuing body. United States. Congress, issuing body.
- Publication:
- Washington, DC : United States Government Accountability Office, June 28, 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Fraud -- prevention & control Government Regulation Medicare Part C -- economics United States Centers for Medicare & Medicaid Services (U.S.)
- Genre(s):
- Technical Report
- Abstract:
- Why GAO did this study. The Medicare program, which includes MA, is on GAO’s High Risk List, because of its size, complexity, and susceptibility to mismanagement and improper payments. Under MA, CMS pays MA organizations a fixed monthly amount per Medicare beneficiary to provide health care coverage no matter how many services are provided or how much those services cost. These organizations can retain savings if their costs to provide services are lower than their payments, but can incur losses if their costs exceed payments. In 2021, Medicare paid MA organizations about $350 billion to provide health care benefits to about 27 million beneficiaries. This testimony is based on GAO’s prior work and focuses on, among other things, key findings and the status of CMS’s efforts to implement GAO recommendations related to (1) monitoring disenrollments from MAOs by Medicare beneficiaries in the last year of life, and (2) validating encounter data used to risk adjust MA organization payments. This testimony draws from GAO reports on Medicare Advantage issued from 2014 through 2021 (GAO-21-482, GAO-16-76, GAO15-710, and GAO-14-571). GAO also reviewed documents from CMS regarding steps taken to address GAO’s recommendations.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (12 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918470886006676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918470886006676