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HRD-82-6 1 (1981-10-23)

handle is hein.gao/gaobabcor0001 and id is 1 raw text is: BY THE COMPTROLLER GENERAL Report To The Congress OF THE UNITED STATES Medicaid's Quality Control System Is Not Realizing Its Full Potential edicaioi's quality control program (which ncludes analyses of a sample of cases) identi- fies problems which result in erroneous pay- ments and devises methods for overcoming hese problems. Potentially severe penalties against States exceeding target error rates have been tied to the program, resulting in luality control focusing on data collection instead of corrective action. GAO recom- mends that the Congress establish a balanced System of less severe penalties for poor tate performance and rewards for good per- :formance. This would redirect the program 'toward making sure that problems are corrected. In turn, future erroneous payments would be minimized. IMany inaccuracies and weaknesses in sample cases cast doubt on the validity of quality control findings. Therefore, GAO believes the error rates developed by quality control are not adequate bases for assessing penalties. GAO also recommends to the Secretary of Health and Human Services several modifica- tions to quality control processes which would provide more useful information for corrective action purposes. 'FD S?7q 116702 H HRD-82-6 Ic0Ju OCTOBER 23,1981

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