Follow-up Audit of General Accounting Office Report "Medicare - Reasonableness of Health Maintenance Organization Payments Not Assured"

EXECUTIVE SUMMARY:

This final report is our follow-up audit of the General Accounting Office (GAO) report entitled, "Medicare - Reasonableness of Health Maintenance Organization Payments Not Assured" (GAO/HRD-89-41). The objective of our follow-up review was to ensure that the specific audit recommendations unconditionally accepted by the Health Care Financing Administration were satisfactorily implemented or appropriately resolved. Our review showed that the Department of Health and Human Services (HHS) either has implemented or is implementing six of the seven GAO recommendations. The remaining recommendation concerning placing a health maintenance organization under a corrective action plan if it used inappropriate data in preparing its adjusted community rate proposal was not accepted by HHS.

---