Tag: GAO

US plan to shield science from “inappropriate influence”

Volume 401, Issue 10375
11 February 2023 

 

WORLD REPORT  The Biden administration is launching a new initiative on scientific integrity in federal agencies following multiple lapses. Susan Jaffe reports from Washington, DC.

Just a week after Joe Biden was sworn in as president in January, 2021, he created a multi-agency Task Force on Scientific Integrity to restore “trust in government through scientific integrity and evidence-based policy making”…Last month, the White House Office of Science and Technology Policy released A Framework for Federal Scientific Integrity and Practice, a follow-up to the task force’s 2022 recommendations that provides a blueprint for implementation. [Continued here.] …

HHS Proposes To Streamline Medicare Appeals Process

By Susan Jaffe  | Kaiser Health News | June 29, 2016 | This KHN story also ran on     nprlogo_138x46

The Department of Health and Human Services Tuesday proposed key changes in the Medicare appeals process to help reduce the backlog of more than 700,000 cases involving denied claims.

The measures “will help us get a leg up on this problem,” said Nancy Griswold, chief law judge of the Office of Medicare Hearing and Appeals.

If there weren’t a single additional appeal filed and no changes in the system, it would take 11 years to eliminate the backlog, Griswold said in an interview. [Continued on NPR or KHN]  …

Medicare’s Efforts To Curb Backlog Of Appeals Not Sufficient, GAO Reports

By Susan Jaffe  | Kaiser Health News |  June 10, 2016

 Despite interventions by Medicare officials, the number of appeals from health care providers and patients Growing Wait Time1challenging denied claims continues to spiral, increasing the backlog of cases and delaying many decisions well beyond the timeframes set by law, according to a government study released Thursday.

The report from the Government Accountability Office, said the backlog “shows no signs of abating.” It called for the Department of Health and Human Services to improve its oversight of the process and to streamline appeals so that prior decisions are taken into account and repetitive claims are handled more efficiently.

HHS officials have acknowledged the problem. Although a judge is required to issue a decision within 90 days, the average time from hearing request to decision is slightly more than two years, Nancy Griswold, the chief administrative law judge of the Office of Medicare Hearings and Appeals, said in an interview.

Requests for hearings increased “so dramatically and so quickly over the past four or five years — during a period of time when our adjudication capacity was not able to keep up for funding reasons — we were drowning” in appeals, she said. “It is not quite as bad right now, but we are unable to keep up with [those] that are coming in the door.”  [Continued]…

Medicare Advantage Plans Need Tougher Oversight, GAO Says

By: | Connecticut Health Investigative Team Writer | October 5, 2015
Federal investigators have found that Medicare officials rarely enforce rules for private insurance plans intended to make sure beneficiaries will be able to see a doctor when they need care.
It’s a problem many Connecticut seniors know too well. In 2013, UnitedHealthcare, the nation’s largest health insurance company, dropped hundreds of health care providers from its C-HITConnecticut Medicare Advantage plan, including 1,200 doctors at the Yale Medical Group and Yale-New Haven Hospital. Medicare Advantage beneficiaries scrambled to find new insurance or new doctors while the Fairfield and Hartford counties medical associations went to court to try to stop the terminations.
The report by the Government Accountability Office, the investigative arm of Congress, said that Medicare did not check provider networks to ensure that doctors were available to beneficiaries and cited Connecticut as a “case study” in what can go wrong.
The GAO report shows that Medicare “was not verifying network adequacy. That’s their job and they abdicated that responsibility,” said U.S. Rep. Rosa DeLauro, D-New Haven, who requested the investigation along with other members of the Connecticut congressional delegation. MORE
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