Comprehensive Planning by the Department of Health and Human Services (“HHS”) Needed to Meet National Needs

An adequate, well-trained, and diverse healthcare workforce is essential for providing access to quality healthcare services. GAO was asked to review HHS’s workforce efforts. In the report, GAO examines (1) HHS’s planning efforts for ensuring adequate supply and distribution of the nation’s healthcare workforce; and (2) the extent to which individuals in HHS health care workforce programs contribute to meeting national needs.

National Background Check Program for Long Term Care Employees Still in the Works

Long Term Care employees provide care to elderly patients in settings such as skilled nursing facilities, home health agencies, and hospices. Ensuring that these employees have undergone the requisite background checks and appropriate levels of screening helps protect patient safety. The ACA provides grants to states to implement background check programs for prospective Long Term Care employees. 

Centers For Disease Control and Prevention Urges Rapid Antiviral Treatment for High Risk Patients

Flu season is here again and the Centers for Disease Control and Prevention (CDC) has received reports of severe episodes of the flu. Seasonal flu accounts for substantial morbidity and mortality every year. The CDC estimates that the 2014-2015 season flu accounted for 970,000 hospitalizations. 

Providers Terminated From One State Medicaid Program Continued Participating in Other States

Prior to the passage of the Affordable Care Act (ACA) in 2010, providers terminated from participation in one State’s Medicaid program for committing acts of fraud, waste, and abuse could potentially enroll in or continue participation in another State’s Medicaid program. Section 6501 of the ACA required effective January 1, 2011, that each state must terminate the participation of a provider from its State Medicaid program if that provider’s participation was terminated from Medicare or from another State Medicaid program. States continue to face challenges meeting the intent of the legislation for several reasons. 

Inappropriate Payments and Questionable Billing for Medicare Part B Ambulance Transports

In a review conducted by the Office of the Inspector General (OIG) and featured in the Semiannual Report to Congress, the OIG continues to identify the need for the Centers for Medicare and Medicaid Services (CMS) to reevaluate ambulance transports billing practices, specifically, transports of beneficiaries within designated geographical locations.

Skilled Nursing Facility Billing for Changes in Therapy: Improvements Are Needed

In a review conducted by the Office of the Inspector General (OIG) and featured in the Semiannual Report to Congress, the Centers for Medicare and Medicaid Services (CMS) continue to reevaluate the skilled nursing facility (SNF) payment system. The report revealed that Medicare payments for therapy greatly exceeded the SNF’s costs for providing therapy services.

Posted on January 22, 2016 .

Incorrect Coding Results in Potential Medicare Overpayments to Physicians

In a review conducted by the Office of the Inspector General (OIG) and featured in their Semiannual Report to Congress,   Medicare contractors were found to have overpaid physicians approximately $33.4 million dollars due to incorrect submissions of Part B claims reviewed during the period from January 2010 through September 2012.  The OIG conducted a nationwide review using a computer match program to identify non-facility coded physician services against submitted Part B claims.