Poor grand-ma and grand-pa! Medicare Gao report

greenspun.com : LUSENET : TimeBomb 2000 (Y2000) : One Thread

Here's another frank and quite disturbing report. This one is from HCFA who manages Medicare. It's a 53 page report, 800+ kb so I'll just paste the beginning here. You'll need Acrobat reader as it's a pdf file: http://www.gao.gov/new.items/ai98284.pdf

It's starts with this on page 3:

"For a program as large and complex as Medicare-paying about $207 billion in benefits for about 39 million beneficiaries-addressing the Y2K problem is a formidable task. The Medicare program uses 7 standard Medicare claims processing systems, over 70 private contractors, and financial institutions nationwide to process about 800 million Medicare claims each year for about 1 million hospitals, physicians, and medical equipment suppliers. Over 85 percent of these Medicare claims are submitted and paid electronically, which will require that electronic data exchanges also be assessed for Y2K compliance.

In view of the impact this problem could have on millions of elderly and disabled American citizens, you requested that we provide information on HCFA's progress in addressing the Y2K issue for its Medicare claims processing systems. During our review, we assessed the extent to which HCFA is (1) making progress in renovating its Medicare systems to be Y2K compliant, (2) directing and overseeing the Y2K effort, (3) ensuring that all data exchanges necessary for processing Medicare claims are identified,renovated, tested, and validated, and (4) developing and initiating business continuity and contingency plans for key business processes.

HCFA and its contractors are severely behind schedule in repairing, testing,and implementing the mission-critical systems supporting Medicare. HCFA has recently begun improving its management of Y2K matters, including establishing a Y2K organization and hiring independent contractors to assist in overseeing the Y2K work. However, because of the complexity and magnitude of the problem and HCFA's late start, its progress in repairing mission-critical Medicare systems for the year 2000 is far behind schedule. Specifically, in August HCFA reported that as of June 30, 1998, less than a third of Medicare's 98 mission-critical systems had been fully renovated, and none had been validated or implemented. The Office of Management and Budget (OMB) has established target dates of September 30, 1998, for completion of agencies' Y2K renovations; January 31, 1999, for validation; and March 31, 1999, for implementation of renovated and validated systems. Compounding this difficult task is HCFA's lack of key management practices necessary to adequately direct and monitor its Y2K project. To date, HCFA has not

 developed an adequate overall schedule and a critical path that identifies and ranks Y2K tasks, and helps ensure that they can be completed in a timely manner,  implemented risk management processes necessary to highlight potential technical and managerial weaknesses that could impair project success, and  planned for or scheduled end-to-end testing to ensure that Medicare-wide renovations will work as planned."

It ends with this on page 50:

"HCFA has provided more detail concerning its budget requests for Y2K renovation projects. This additional information should be useful to OMB and the Congress in analyzing HCFAs Y2K effort and understanding its planned approach for the next few years. It should be noted that OMBs most recent quarterly report on governmentwide Year 2000 progress did not include HHS recent estimate of Y2K costs for fiscal year 2000. According to OMB, approximately $550 million in FY 2000 costs is still being reviewed by OMB. Almost all of these costs are attributable to HCFA.

Revealing in where the government's priorities and concerns are. Certainly not for the elderly, who paid in the most money over the years and made the government what it is today. That's the thanks they get :-(

-- Chris (catsy@pond.com), October 19, 1998


Sad, but probably true. One of the problems with Y2K projects is that no one wants them - often they are passed from section to section in the IS dept. like an unwanted stepchild. There is no glory or promotion likely from fixing the problems in someone elses program. IMHO that is why the outfits that went with total system rebuild are doing well, while the ones that are just going for massive patches are generally doing poorly.

-- Paul Davis (davisp1953@yahoo.com), October 19, 1998.

There was a "small" report in the paper (in mid-September) stating that Medicare overcharged seniors by 540 million dollars (that Congress will have to repay) by calculating their (the seniors) deuctibles wrong.

The report indicated the failure was due to "Y2K changes."

Sounds like even the pieces that aren't finished, aren't getting finished correctly.

This is why I firmly believe the government is in bigger trouble than any industry, than any utiltity - they can't recover from where they are right now, and didn't get enough people in the right places working long to even find everything that will fail....

And they can't stop it from failing......the programs will fail (or just stop, maybe that's better than giving bad data) regardless of what the politicians say....

-- Robert A. Cook, P.E. (Kennesaw, GA) (cook.r@csaatl.com), October 20, 1998.

Here's the whole thing, from AP, from the Tuesday, 1 Sept 1998, Marietta Daily Journal.

"Computer Trouble Will deny Madicare Savings.


Senior citizens will miss out on as much as $570 million in savings on their Medicare co-payments because of delays while the government fixes a computer glitch that threatens to shut down computers on Jan 1, 2000.

Elderly and disabled Americans covered by Medicare pay 20% of the bills for mostt medical care out of their own pockets or by buying private suplemental insurance.

But an accounting problem has stuck them with 50% of the bill,on average, for tests, one-day surgery, and rehabilition services received in hospital outpatient clinics.

Congress and the Clinton administration agreed last summer that starting in 1999 Medicare should correct the problme by taking over a slightly bigger share of the outpatient bills each year until reirees co-payments are down to the ususal 20% percent."

Hmmmm. So the Clinton adminstration neveractually said they'd pay it all back, just "eventually" return to the previous 20% co-payment. I thought this was the group that promised to save our parents....

-- Robert A. Cook, P.E. (cook.r@csaatl.com), October 21, 1998.

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