Medicare and Medicaid

More Information Exchange Could Improve Detection of Substandard Care Gao ID: HRD-90-29 March 7, 1990

GAO provided information on the Health Care Financing Administration's (HCFA) implementation of a recommendation that it develop guidelines to coordinate reporting on Medicaid and Medicare quality of care.

GAO found that: (1) review entities, including insurance carriers and peer review organizations (PRO), did not routinely exchange information about problem physicians; (2) officials agreed that data exchange would be useful; and (3) there were no statutory provisions that would prevent data exchange. GAO also found that HCFA: (1) proposed an amendment requiring PRO to routinely disclose information to licensing boards and accrediting bodies when submitting sanctioning reports; (2) required PRO to release certain information upon request; and (3) required PRO to routinely supply provider information to review entities and state licensing boards.

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.

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