Medicaid Program Integrity
Medicaid Program Integrity

Author: United States. Government Accountability Office

Publisher: Createspace Independent Publishing Platform

Published: 2017-12-21

Total Pages: 48

ISBN-13: 9781981885091

DOWNLOAD EBOOK

MEDICAID PROGRAM INTEGRITY: CMS Should Build on Current Oversight Efforts by Further Enhancing Collaboration with States

Medicaid Program Integrity, CMS Should Build on Current Oversight Efforts by Further Enhancing Collaboration with States
Medicaid Program Integrity, CMS Should Build on Current Oversight Efforts by Further Enhancing Collaboration with States

Author: U.s. Government Accountability Office

Publisher: Createspace Independent Publishing Platform

Published: 2017-07-12

Total Pages: 48

ISBN-13: 9781548830601

DOWNLOAD EBOOK

" Medicaid remains a high-risk program, partly due to concerns about improper payments. CMS oversees and supports states, in part, by reviewing their program integrity activities, hiring contractors to audit providers, and providing training. In recent years, CMS made changes to its Medicaid program integrity efforts, including a shift to collaborative audits. GAO was asked to examine CMS's oversight and support of states' Medicaid program integrity efforts. GAO examined, among other issues, (1) how CMS tailors its reviews to states' circumstances; (2) states' experiences with collaborative audits; and (3) CMS's steps to share promising program integrity practices. GAO reviewed CMS documents, including state program integrity reports, and data on collaborative audits. GAO interviewed officials from CMS and eight states selected based on expenditures, managed care use, and number of collaborative audits, among other factors. "

Health Care Fraud and Abuse
Health Care Fraud and Abuse

Author: Aspen Health Law Center

Publisher:

Published: 1998

Total Pages: 156

ISBN-13:

DOWNLOAD EBOOK

Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.

Leadership by Example
Leadership by Example

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2003-05-21

Total Pages: 206

ISBN-13: 0309168880

DOWNLOAD EBOOK

The federal government operates six major health care programs that serve nearly 100 million Americans. Collectively, these programs significantly influence how health care is provided by the private sector. Leadership by Example explores how the federal government can leverage its unique position as regulator, purchaser, provider, and research sponsor to improve care - not only in these six programs but also throughout the nation's health care system. The book describes the federal programs and the populations they serve: Medicare (elderly), Medicaid (low income), SCHIP (children), VHA (veterans), TRICARE (individuals in the military and their dependents), and IHS (native Americans). It then examines the steps each program takes to assure and improve safety and quality of care. The Institute of Medicine proposes a national quality enhancement strategy focused on performance measurement of clinical quality and patient perceptions of care. The discussion on which this book focuses includes recommendations for developing and pilot-testing performance measures, creating an information infrastructure for comparing performance and disseminating results, and more. Leadership by Example also includes a proposed research agenda to support quality enhancement. The third in the series of books from the Quality of Health Care in America project, this well-targeted volume will be important to all readers of To Err Is Human and Crossing the Quality Chasm - as well as new readers interested in the federal government's role in health care.