Medicare: Experience Shows Ways to Improve Oversight of Health Maintenance Organizations

Abstract

This report discusses problems with the Health Care Financing Administration's (HCFA) ability to deal decisively with health maintenance organizations (HMOS) with compliance problems that they are either unwilling or unable to resolve in a timely manner. The report contains a matter for the Subcommittee's consideration regarding increasing HCFA's discretion in applying its authority to suspend Medicare enrollments in HMOS that fail to take timely actions to resolve, or show substantial progress toward resolving, Medicare compliance or financial problems. The report recommends that the Administrator of HCFA be directed to (1) issue regulations specifying the purpose, circumstances, and procedures for authorizing retroactive disenrollments and (2) establish a formal tracking system to follow requests for corrective actions and the subsequent actions taken by the HMOS.

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Document Details

Document Type
Technical Report
Publication Date
Aug 17, 1988
Accession Number
ADA199343

Entities

Organizations

  • United States Government Accountability Office

Tags

DTIC Thesaurus Topics

  • California
  • Case Studies
  • Congress
  • Contracts
  • Databases
  • Health
  • Health Care
  • Health Maintenance Organizations
  • Health Services
  • Hospitals
  • Law
  • Management Personnel
  • Medical Personnel
  • Money
  • Organizational Structure
  • Personnel Management
  • Public Health

Readers

  • Government and Public Administration Law.
  • Medical or Health Care Field.