Medicaid

Legislation Needed to Improve Collections From Private Insurers Gao ID: HRD-91-25 November 30, 1990

Pursuant to a congressional request, GAO reviewed problems that state Medicaid agencies experienced in collecting from third parties, focusing on out-of-state insurers and employee health benefit plans covered under the Employee Retirement Income Security Act of 1974 (ERISA).

GAO found that: (1) states lacked jurisdiction over insurers that operated only incidentally in the state; (2) states' limited authority over ERISA plans did not allow them to prohibit those plans from certain actions to avoid payments for recipients' covered costs; (3) state officials could not easily identify Medicaid losses through their payment systems, but federal agency information indicated that the losses could be substantial and were likely to increase; and (4) to minimize future losses, states will need federal legislation to clarify Medicaid's role as payer of last resort and enhance their ability to collect from out-of-state insurers and ERISA plans.

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: Team: Phone:


The Justia Government Accountability Office site republishes public reports retrieved from the U.S. GAO These reports should not be considered official, and do not necessarily reflect the views of Justia.