Medicare: Opportunities and Challenges in Contracting for Program Safeguards

摘要

Because of its size and complexity, we designated Medicare in 1990 as being athigh risk for fraud, waste, abuse, and mismanagement and that designation continues today. The Congress passed the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in part to provide better stewardship of the program. This act gave the Health Care Financing Administration (HCFA)-the agency that administers Medicare-the authority to contract with specialized entities to combat fraud, waste, and abuse. In May 1999, HCFA selected 12 of these specialized entities to act as program safeguard contractors (PSCs). A little over a year later, you asked us to review HCFA's implementation of its new contracting authority. Specifically, you requested that we (1) describe HCFA's progress in implementing its PSC contracting authority and (2) assess whether HCFA could improve its management of the PSCs to ensure their most effective use.