Internal Controls: Need to Strengthen Control Over Payments by Medicare Intermediaries

摘要

This GAO report involves a study of the effectiveness of internal controls that federal managers use for assuring that payments by Medicare intermediaries are made in accordance with federal laws and are adequately safeguarded against fraud, waste, and abuse. Intermediaries are the Health Care Financing Administration's (HCFA'S) Medicare agents that pay for services provided primarily by hospitals and other institutional providers. Organizations that pay for services provided by physicians and other noninstitutional providers are called carriers. This report focuses on HCFA'S controls over intermediaries. Internal controls are an integral part of systems that managers use to guide their operations. They include an agency's organization and methods and procedures used to ensure that 1) resource use is consistent with laws, regulations, and policies; 2) resources are safeguarded against waste, loss, and misuse; and 3) reliable data are obtained, maintained, and fairly disclosed in reports. (KR)