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HRD-85-79 1 (1985-06-28)

handle is hein.gao/gaobabnsp0001 and id is 1 raw text is: ( n' .rj UNITED STATES GENERAL ACCOUNTING OFFICE WASHINGTON. D.C. 20548 HUMAN NEUOURCZU DIVISION bythe c. B-219002 The Honorable John Heinz RELEASED Chairman, Special Committee on Aging 127496 United States Senate Dear Mr. Chairman: Subject: Medicare Part B Beneficiary Appeals Process (GAO/HRD-85-79) This is in response to your request for information about claims processing and due process protections for beneficiaries under part B of Medicare, the supplementary medical insurance program under title XVIII of the Social Security Act. Specifi- cally, you asked for information on (1) the adequacy of the beneficiary appeals process under the due process principle of the Constitution and (2) the extent to which the Department of Health and Human Services' (HHS') Health Care Financing Adminis- tration (HCFA), which administers Medicare, has implemented certain prior GAO recommendations directed at preventing under- payments to beneficiaries. You also asked for data on the extent and outcome of beneficiary appeals under part B. Our review of court decisions related to the part B appeals process showed that courts have found HHS' appeals procedures did not satisfy the requirements of due process. HHS has taken some actions in response to these court decisions, and the courts are reviewing these actions to determine their suffi- ciency. HHS said that it has not acted to implement our 1980 and 1981 recommendations to improve protection against underpayments to beneficiaries because to do so would increase administrative costs and program payments. While we recognize that costs would increase if our recommendations are implemented, taking the ac- tions we recommended would help assure that beneficiaries re- ceive the benefits they are entitled to by law. The statistical information on beneficiary appeals that you requested is contained in HCFA's quarterly Carrier ARpeals Report. A copy of the September 1984 report was provided to your office on October 11, 1984. (106273)

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