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HRD-81-45 1 (1980-12-16)

handle is hein.gao/gaobabbiq0001 and id is 1 raw text is: ,.4 r 1 91 UNITED STATES GENERAL ACCOUNTING OFFICE WASHINGTON, D.C. 20548 December 16, 1980 HUMAN RISOURCrS nlVISlON B-200211 1131111111 113991 The Honorable Charles Rangel Chairman, Subcommittee on Health Ways and Means Committee House of Representatives Dear Mr. Chairman: Subject: Review of Alleged Questionable Actions by EDSF to Reduce its Claims and Correspondence Backlogs Under its Medicare Contract in Illinois (HRD-81-45) This is in response to your request for a report on several allegations of questionable actions by Electronic Data Systems Federal Corporation (EDSF), the Illinois Medicare part B carrier, to reduce backlogs of pending claims and correspondence. We are continuing o examine other aspects of EDSF's operations as part of our broader review of Medi- care's firm fixed-price contracting experiments, which in- cludes a review of the experimental contract in Illinois as well as two other experimental contracts in New York and Maine. A report to you on all three experiments is now planned for June 1981. The allegations, which appeared in the Chicago newspapers beginning on August 19, 1980, pertained primarily to actions by EDSF managers to deal with large backlogs of Medicare claims and correspondence. The details of the allegations were obtained through lengthy interviews and signed state- ments from several former employees. The allegations presented to us by the former employees basically fall into two categories. One category of alle- gations involves the actions taken by EDSF during the last quarter of 1979 to deal with the problem of a large backlog (106183) 'g-

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