Medicare Health Maintenance Organizations: The IMC Experience : Hearing Before a Subcommittee of the Committee on Government Operations, House of Representatives, One Hundredth Congress, First Session, December 15, 1987, Volume 4U.S. Government Printing Office, 1988 - 205 pages |
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... correct ? Mr. KUSSEROW . That is correct . Mr. WEISS . You mentioned this , but would you go through it again ? What is a risk - based contract ? Mr. KUSSEROW . Well , a risk - based contract basically is that you get a set - what they ...
... correct ? Mr. KUSSEROW . That is correct . Mr. WEISS . You mentioned this , but would you go through it again ? What is a risk - based contract ? Mr. KUSSEROW . Well , a risk - based contract basically is that you get a set - what they ...
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... correct . Mr. WEISS . But if in fact it spent $ 1,200 , it would be losing $ 200 ? Mr. KUSSEROW . That is correct . Mr. WEISS . OK . Under a risk contract , then , the sicker the pa- tient , the more it costs the HMO . Is that right ...
... correct . Mr. WEISS . But if in fact it spent $ 1,200 , it would be losing $ 200 ? Mr. KUSSEROW . That is correct . Mr. WEISS . OK . Under a risk contract , then , the sicker the pa- tient , the more it costs the HMO . Is that right ...
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... correct ? Mr. KUSSEROW . That is correct . Mr. WEISS . The audit found nearly $ 2.5 million in unallowable costs charged to the Medicare Program by that one affiliate alone ; is that correct ? Mr. KUSSEROW . That is correct . But I ...
... correct ? Mr. KUSSEROW . That is correct . Mr. WEISS . The audit found nearly $ 2.5 million in unallowable costs charged to the Medicare Program by that one affiliate alone ; is that correct ? Mr. KUSSEROW . That is correct . But I ...
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... correct ? Mr. KUSSEROW . He was the contracting officer , but he did not have final approval . Mr. WEISS . I would like to refer you to an Office of Inspector General memo of an interview conducted on September 18 , 1986 , which refers ...
... correct ? Mr. KUSSEROW . He was the contracting officer , but he did not have final approval . Mr. WEISS . I would like to refer you to an Office of Inspector General memo of an interview conducted on September 18 , 1986 , which refers ...
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... correct ? Mr. KUSSEROW . That is correct . Mr. WEISS . And IMC agreed that it would be limited to Dade County and that the company would be subject to monitoring ; is that right ? Mr. KUSSEROW . That it would be in the environs of Dade ...
... correct ? Mr. KUSSEROW . That is correct . Mr. WEISS . And IMC agreed that it would be limited to Dade County and that the company would be subject to monitoring ; is that right ? Mr. KUSSEROW . That it would be in the environs of Dade ...
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Expressions et termes fréquents
50 percent affiliated providers agency asked audit Chairman complaints concern conflict of interest Congressman correct costs counties Dade County DATE ACTIVITY December 15 decision demonstration employees enrollees enrollment standard fact Federal qualification Financing Administration Florida former HHS FOWLER freedom-of-choice George Reeb going GOULET HADDOW HCFA Health and Human Health Care Financing Health Maintenance Organizations Heckler HMO's hospital Human Services IMC contract IMC's inspector International Medical Centers investigation issue Jeb Bush Juan del Real Kevin Moley kind KUSSEROW law firm letter LIGHTFOOT Lyn Nofziger Medicaid Medicare beneficiaries Medicare contract Medicare enrollment Medicare Program ment Miami Miguel Recarey million MOLEY non-Medicare OHMO operations paid patient payment PELOSI PRIVATE HEALTH PLANS problems PRUSSIN qualification officer Recarey's received recommendations regulations requirement responsibility risk-based SAWYER staff statement subcommittee TEFRA terminate testimony Thank things tion waiver Wayne Fowler WEISS
Fréquemment cités
Page 92 - Administrator similarly cited the value of work done by the Department of Health and Human Services Office of the Inspector General and IV&V vendors at contractor sites in uncovering problems.
Page 97 - Did you have a statement that you would like to make? STATEMENT OF ROBERT F.
Page 72 - Mr. Chairman, this concludes my statement and I will be pleased to answer any of your questions.
Page 6 - THE SUBCOMMITTEE ON HUMAN RESOURCES AND INTERGOVERNMENTAL RELATIONS OF THE COMMITTEE ON GOVERNMENT OPERATIONS HOUSE OF REPRESENTATIVES FEBRUARY 18, 1988 Mr.
Page 176 - ... is introduced (substantially curtailing the right to contest license renewals, guaranteed to the public by the Communications Act of 1934) that it is supported by 23 Senators and 118 Congressmen? The broadcasting industry is, without question, the single most powerful lobby in our nation's history. What should we do about it? What can we do about it? Once the Big Broadcasting-Big Business axis has kidnapped and run off with the democratic process is there anyway of guaranteeing its safe return?
Page 85 - Mr. Chairman, this concludes my statement. I will be pleased to respond to any questions that you may have at this time.
Page 117 - ... organization's enrollment may be Medicare and Medicaid beneficiaries. (2) Waiver of composition of enrollment standard. Unless limited by the criteria specified in paragraph (d)(3) of this section, HCPA may waive compliance with the requirements of paragraph (d)<l) of this section if— (i) The organization is making reasonable efforts to enroll individuals who are not Medicare or Medicaid beneficiaries; and (ii) Medicare and Medicaid beneficiaries constitute more than 50 percent of the population...
Page 158 - ... this subcommittee the benefit of your experience and programs. We appreciate your being a witness. At this point I would like to have entered into the record a statement by Senator Bellmon. He was not able to get here to present it in the opening, so it will be entered into the record in its entirety. STATEMENT OF HON. HENRY BELLMON, A US SENATOR FROM THE STATE OF OKLAHOMA Senator BELLMON. Mr. Chairman, members of the subcommittee : At the outset I want to say how pleased I am that this special...
Page 158 - DIRECTOR, OFFICE OF HEALTH MAINTENANCE ORGANIZATIONS, DEPARTMENT OF HEALTH AND HUMAN SERVICES; AND HAROLD HUNTER, DIRECTOR, RESEARCH AND DEVELOPMENT, GROUP HEALTH ASSOCIATION OF AMERICA Mr.
Page 89 - I appreciate your taking the time to testify before the Government Operations Human Resources and Intergovernmental Relations Subcommittee on December I5.