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Medicaid financing : states' use of contingency-fee consultants to maximize federal reimbursements highlights need for improved federal oversight : report to the chairman, Committee on Finance, U.S. Senate

Author: United States. Government Accountability Office,; United States. Congress. Senate. Committee on Finance.
Publisher: Washington, D.C. : U.S. Government Accountability Office, June 2005.
Edition/Format:   Print book : Document : National government publication   Computer File : EnglishView all editions and formats
Database:WorldCat
Summary:
Why GAO did this study: Medicaid-the federal-state health care financing program covering nearly 54 million low-income people at a cost of $276 billion in fiscal year 2003-is by its size and structure at risk of waste and exploitation. Because of challenges inherent in overseeing the program, administered federally by the Centers for Medicare & Medicaid Services (CMS), GAO in 2003 added Medicaid to its list of  Read more...
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Genre/Form: Technical Report
Material Type: Document, Government publication, National government publication, Internet resource
Document Type: Book, Computer File, Internet Resource
All Authors / Contributors: United States. Government Accountability Office,; United States. Congress. Senate. Committee on Finance.
OCLC Number: 61141187
Notes: "GAO-05-748."
Description: iii, 92 leaves : illustrations
Responsibility: United States Government Accountability Office.

Abstract:

Why GAO did this study: Medicaid-the federal-state health care financing program covering nearly 54 million low-income people at a cost of $276 billion in fiscal year 2003-is by its size and structure at risk of waste and exploitation. Because of challenges inherent in overseeing the program, administered federally by the Centers for Medicare & Medicaid Services (CMS), GAO in 2003 added Medicaid to its list of high-risk federal programs. To help administer the program, states may employ consultants in a number of roles, sometimes under contracts whereby payment is contingent upon the consultant's performance. GAO was asked to report on states' use of contingency-fee consultants. GAO examined the extent to which (1) states are using contingency-fee consultants for projects to maximize federal Medicaid reimbursements, (2) claims from contingency-fee projects in selected states are consistent with federal law and policy, and (3) states and CMS are overseeing claims from such projects. What GAO recommends: GAO recommends that CMS improve oversight of contingency-fee projects and states' reimbursement-maximizing methods. In comments, CMS said its initiatives substantially respond to the recommendations, and the states said that their projects comply with law. GAO maintains that additional actions are needed.

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