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HRD-93-19R 1 (1993-03-31)

handle is hein.gao/gaobackil0001 and id is 1 raw text is: GAO United States General Accounting Office Washington, D.C. 20548 Human Resources Division 149337 B-251773 March 31, 1993 The Honorable Patricia Schroeder Chairwoman, Select Committee on Children, Youth and Families House of Representatives Dear Madam Chairwoman: This letter responds to your September 25, 1992 request that we examine the Department of Defense's (DOD) efforts to evaluate the appropriateness of psychiatric care provided to its beneficiaries under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). Specifically, this letter addresses (1) the extent to which DOD has followed up on the findings of its mental health care utilization management contractor, Health Management Strategies International, Inc. (HMS); (2) DOD's future plans for reviewing the appropriateness of CHAMPUS psychiatric care; and (3) how regulations prohibiting certain mental health provider practices under CHAMPUS compare with Medicare. To determine the validity of HMS's findings, we reviewed the medical records for several hospital admissions and stays that HMS judged to be medically unnecessary. Additionally, we met with the Acting Assistant Secretary of Defense (Health Affairs), his representatives, and HMS to discuss DOD's follow-up activity and future plans. We also compared regulations governing Medicare and CHAMPUS to determine if protections and authorities for dealing with provider fraud and abuse were similar under both programs. In our April 28, 1992 testimony before the Select Committee,1 we reported that HMS had identified a number of instances of potentially unnecessary hospital 'Defense Health Care: Efforts to Manage Mental Health Care Benefits to CHAMPUS Beneficiaries (GAO/T-HRD-92-27, Apr. 28, 1992). GAO/HRD-93-19R DOD Mental Health Review Efforts

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