skip navigation

PUBLICATIONS

Register for Latest Research

Stay Informed
Register with NCJRS to receive NCJRS's biweekly e-newsletter JUSTINFO and additional periodic emails from NCJRS and the NCJRS federal sponsors that highlight the latest research published or sponsored by the Office of Justice Programs.

NCJRS Abstract

The document referenced below is part of the NCJRS Virtual Library collection. To conduct further searches of the collection, visit the Virtual Library. See the Obtain Documents page for direction on how to access resources online, via mail, through interlibrary loans, or in a local library.

 

NCJ Number: 63927 Add to Shopping cart Find in a Library
Title: ERRORS IN HEALTH BENEFITS ENROLLMENT DATA PUSH UP INSURANCE COSTS
Author(s): ANON
Corporate Author: US Government Accountability Office
United States of America
Date Published: 1979
Page Count: 20
Sponsoring Agency: US Government Accountability Office
Washington, DC 20548
Sale Source: US Government Accountability Office
441 G Street, NW
Washington, DC 20548
United States of America
Language: English
Country: United States of America
Annotation: A GENERAL ACCOUNTING OFFICE (GAO) AUDIT OF FEDERAL AGENCIES' PAYROLL SYSTEMS REVEALS MAJOR DISCREPANCIES BETWEEN AGENCY AND CARRIER HEALTH BENEFIT RECORDS.
Abstract: DISCREPANCIES IN ENROLLMENT DATA THAT EXIST BETWEEN AGENCIES' AND CARRIERS' ACCOUNTING RECORDS ARE SIGNIFICANT BECAUSE ENROLLEES ON A CARRIER'S RECORDS MAY RECEIVE BENEFITS WITHOUT PAYING PREMIUMS. INTERNAL AUDITORS IN THE DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE (DHEW) UNCOVERED 10,000 DISCREPANCIES (13 PERCENT DISCREPANCY RATE) WHEN COMPARING ENROLLMENT RECORDS OF BLUE CROSS/BLUE SHIELD AND DHEW'S PAYROLL OFFICE. REASONS FOR THESE DISCREPANCIES INCLUDE FEDERAL AGENCIES' FAILURE TO POST CHANGES AND AN OUTDATED MANUAL SYSTEM FOR EXCHANGING INFORMATION BETWEEN AGENCIES AND CARRIERS. BECAUSE DISCREPANCIES ULTIMATELY INCREASE HEALTH INSURANCE COSTS FOR BOTH THE GOVERNMENT AND ITS EMPLOYEES, THE GAO RECOMMENDS THAT THE USE OF AUTOMATED PROCEDURES BE ADOPTED TO REPORT HEALTH BENEFIT ENROLLMENT DATA TO CARRIERS AND TO RECONCILE AGENCY AND CARRIER ENROLLMENT RECORDS. IN ADDITION, THE USE OF A COMMON IDENTIFYING NUMBER FOR EACH ENROLLEE SHOULD BE ARRANGED WITH CARRIERS TO FACILITATE IDENTIFYING ENROLLMENT DATA. CARRIERS SHOULD BE REQUIRED TO PROVIDE PAYROLL OFFICES WITH VERIFICATION ENROLLMENT DATA IN COMPUTER-READABLE FORM, AND AGENCIES AND CARRIERS SHOULD DEVELOP A STANDARD FORMAT FOR EXCHANGING ENROLLMENT INFORMATION.
Index Term(s): Economic planning; Financial management; Insurance fraud; Public administration; Trade practices; US Government Accountability Office (GAO)
To cite this abstract, use the following link:
http://www.ncjrs.gov/App/publications/abstract.aspx?ID=63927

*A link to the full-text document is provided whenever possible. For documents not available online, a link to the publisher's website is provided. Tell us how you use the NCJRS Library and Abstracts Database - send us your feedback.