Inadequate Controls Over Medicare Payments for Once-in-a-Lifetime Physician Procedures

Gao ID: HRD-84-23 February 13, 1984

GAO evaluated the controls that Medicare carriers have over payments for once-in-a-lifetime physician procedures. The Health Care Financing Administration (HCFA) promulgates program regulations and defines such procedures as certain types of surgical operations and initial service visits.

GAO found that there is a fairly widespread lack of compliance with the HCFA requirement to control payments for these physicians procedures. Overpayments at the two carriers reviewed by GAO indicated that overpayments are probably substantial nationwide.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

Director: Michael Zimmerman Team: General Accounting Office: Human Resources Division Phone: (202) 275-6195


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