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HEHS-95-214R 1 (1995-07-18)

handle is hein.gao/gaobackxg0001 and id is 1 raw text is: 


             United States
GAO          General Accounting Offiee
             Washington, D.C. 20548                 7 11111II [IIIIIIIIII F

             Health, Education and Human Services Division II4971

             B-261970

             July 18, 1995

             The Honorable Ron Wyden
             Ranking Minority Member
             Subcommittee on Oversight and Investigations
             Committee on Commerce
             House of Representatives

             Dear Mr. Wyden:

             Medicare reimburses certain institutional providers for
             their operating expenses, such as buildings and
             equipment, employee salaries, utilities, accounting
             fees, and legal fees.' Concerned about the possible
             abuse of the Medicare provision that allows
             reimbursement of providers' legal expenses, particularly
             by home health agencies, you asked us to provide you
             with information on: (1) the conditions that Medicare
             imposes on provider legal expense reimbursements and
             whether those conditions are different from those
             applied in other government contexts; (2) the amount
             that Medicare spends on providers' legal expenses; and
             (3) whether any evidence exists that providers have
             abused current provisions covering legal expense
             reimbursement.

             BACKGROUND
             The Health Care Financing Administration (HCFA), within
             the Department of Health and Human Services (HHS), is
             responsible for administering the Medicare Hospital
             Insurance Program, also known as Medicare Part A. Part
             A covers the cost of inpatient hospital stays, home
             health care, and hospice and skilled nursing facility
             stays. HCFA contracts with about 52 private companies--
             such as Blue Cross plans and Aetna--to handle claims
             screening and to audit providers of Part A services.
             HCFA contractors review providers' claims and audit
             their cost reports. Contractors may deny claims
             submitted by providers and may determine that certain


             'Institutional providers that are reimbursed by Medicare
             on a cost basis include home health care agencies,
             skilled nursing facilities, rehabilitation, and
             psychiatric hospitals.

                GAO/HEHS-95-214R    Medicare Providers' Legal Expenses

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