OIG Releases 2014 Top Management and Performance Challenges
OIG released its annual analysis of the top current and future challenges facing the Department of Health and Human Services.
- Every year, the Office of Inspector General (OIG) prepares a summary of the most significant management and performance challenges facing the Department of Health and Human Services (HHS). These represent continuing vulnerabilities for HHS over recent years as well as new and emerging trouble areas that will gain steam in the years ahead. The annual report is part of OIG’s requirement under the “Reports Consolidation Act of 2000, Public Law 106-531.”
Ten specific challenges were released. Several of them directly or indirectly impact hospital or practice revenue cycle strategies.
The most noticeable challenge in this realm in Challenge Eight: Ensuring Effective Financial and Administrative Management. The HHS manages healthcare insurance, public health, social services and research programs designed to enhance the health, safety and well-being of all Americans. The financial statement audit found that there is a material weakness in the financial management system when it comes to IT security and a significant deficiency in the financial reporting systems, analysis and oversight. Problems in addressing the potential violations of the Anti-Deficiency Act.
This specific challenge also highlighted improper payments that have cost federal programs billions of dollars annually. For the fiscal year 2013, the Department reported improper payments totaling almost $50 billion in the Medicare program and $65 billion overall.
Several of the other Challenges also have financial implications. A recap of some of them include:
Challenge One: Health Insurance Marketplace – Improved solutions are needed when it comes to financial management and payment systems that produce accurate and timely payments to issuers of advance payment of premium tax credits, cost-sharing reduction amounts and premium-stabilization payments. CMS must also validate information received from issuers to ensure it is timely, complete and accurate for payment purposes.
Challenge Two: Prescription Drugs in Medicare and Medicaid – Questionable utilization and billing practices have been a seen when it comes to fraudulent claims to Medicare for disease beneficiaries. In 2011, more than $1 million for prescription drugs for 5,101 deceased beneficiaries was paid out.
Challenge Three: Expanding Medicaid Program Fraud, Waste and Abuse – In 2013, CMS reported that Medicaid’s improper payment rate was 5.8 percent. The projected federal share of the $24.9 billion improper payments was $14.4 billion and nearly 97 percent of these improper payments were overpayments. The main error was payments for individuals that should not have been enrolled in the program at all.
Challenge Four: Fighting Waste and Fraud and Promoting Value in Medicare Parts A and B – Reducing improper payments, preventing and responding to fraud, fostering economic payment policies and transition from volume-based to value-based payment models all produce specific challenges that need to be addressed. Each of these areas is critical to the success of Medicare and the Affordable Care Act.
