GAO finds flaws in dual-eligible system

July 2, 2007

A Government Accountability Office report found enrollment delays and excessive payments for beneficiaries who are eligible for both Medicare and Medicaid.

A Government Accountability Office report found enrollment delays and excessive payments for beneficiaries who are eligible for both Medicare and Medicaid. According to the report, it takes up to five weeks and multiple administrative steps to enroll dual-eligible beneficiaries. As a result of the complex enrollment system, up to two-thirds of dual eligibles have difficulty obtaining medications because pharmacies do not have accurate prescription drug plan information during the five-week process. In addition, GAO discovered that CMS paid millions of dollars to drug plans to repay dual eligibles retroactively for drugs they had to pay for, but did not inform dual eligibles of the benefit or monitor whether the beneficiaries ever received the money. GAO recommended that CMS require PDPs to notify beneficiaries of their right to reimbursement and monitor implementation of its retroactive payment policy. The report also recommended that CMS take steps to improve the operational efficiency of the program.

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