Medicaid's Quality Control System is Not Realizing Its Full Potential: Report to the Congress

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U.S. General Accounting Office, 1981 - Medicaid - 52 pages

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Page 2 - Association, the national professional association of registered nurses. The American Nurses' Association is the professional organization of over 200,000 registered nurses in 50 States, the District of Columbia, Guam, Puerto Rico, the Virgin Islands, and the Canal Zone. I have with me two members of the staff, Mr. Zembower and Mr. Craig who are members of the staff of the American Nurses' Association to answer any questions you might have.
Page 1 - Medicaid— authorized by title XIX of the Social Security Act, as amended (42 USC 1396...
Page 2 - AFDC family (adjusted for family size) and 133y3 percent of the payment to such AFDC family. All of these variations — in benefits offered, in groups covered, in income standards, and in levels of reimbursement for providers — mean that Medicaid programs differ greatly from state to state. All states require Medicaid patients in longterm care institutions to contribute their excess income (generally all income over the $25 they require for personal needs) to help pay for the cost of their care....
Page 1 - Medicare, this is the Health Care Financing Administration (HCFA), Department of Health and Human Services (HHS).
Page ii - ... of which would reduce erroneous payments. Because the error rates are tied to the penalties, HCFA has placed its emphasis on developing quality control processes and policies which will provide statistically defensible error rates which can withstand challenge if penalties are assessed.
Page 2 - MQC findings), approximately $461 million was paid for health services to ineligible beneficiaries, $74 million was lost in unrecovered third-party liability, and $100 million was wasted through claims processing errors.
Page 11 - Unfortunately, this emphasis on corrective action plans apparently was an effort not so much to improve Medicaid management as to avoid imposing the fiscal penalties.
Page 7 - Because corrective action is the ultimate purpose of MQC, the threat of penalties has partially negated its expected benefits...
Page ii - This could be accomplished by — reducing the magnitude of the penalties for poor performance and — providing rewards of similar magnitude for good performance...
Page 43 - Medicaid's Quality Control System Is Not Realizing Its Full Potential.

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