The Office of Inspector General (OIG) released its annual report this week detailing the 10 most significant challenges facing the Department of Health and Human Services (HHS) this year. Unsurprisingly, concerns about fraud, waste, and abuse in the healthcare system continue to dominate the OIG’s list of challenges. However, this year’s list also introduces new challenges related to Ebola and other communicable diseases as well as healthcare technology and the exchange of electronic health information.
7 of the challenges on this year’s list were included on last year’s list and include:
- Implementing, operating, and overseeing the Health Insurance Marketplaces. For the third year in a row, the OIG lists this as the top challenge facing HHS. According to the OIG, Health Insurance Marketplaces are an integral part of the Affordable Care Act and their success depends on making accurate eligibility determinations, processing enrollments efficiently, and implementing financial management and payment systems.
- Protecting an expanding Medicaid program from fraud, waste, and abuse. Unsurprisingly, the OIG continues to identify fraud, waste, and abuse in the Medicaid program as a major challenge for HHS. The OIG recommends that HHS increase its oversight, particularly as the Medicaid program expands.
- Fighting waste and fraud and promoting value in Medicare Parts A and B. Similarly, the OIG continues to identify fraud, waste, and abuse in Medicare Parts A and B as a major challenge for HHS. Last year, HHS reported $50 million dollars in improper Medicare payments. The OIG recommends that HHS focus its efforts on recovering for improper payments in a timely manner.
- Ensuring quality in nursing home, hospice, and home health. The OIG raises concerns about the quality of nursing home, hospice, and home health care. Notably, nursing home care was left off the OIG’s list of challenges in 2012, but was added back in 2013 as the number 7 challenge. This year, the OIG ranks nursing home care as the number 5 challenge and identifies quality of hospice and home health care as additional areas of concern. The OIG recommends as a solution that HHS link payment to quality-of-care requirements.
- Ensuring appropriate use of prescription drugs in Medicare and Medicaid. The OIG is concerned that suspicious billing patterns may indicate that Medicare and Medicaid beneficiaries are receiving inappropriate prescription drugs and selling them illegally; that pharmacies are billing for drugs that beneficiaries are never receiving; and that Medicare identification numbers are being stolen. The OIG recommends that HHS increase its oversight of prescription drug utilization.
- Protecting HHS grants and contract funds from fraud, waste, and abuse. According to the OIG, federal grant programs remain vulnerable to fraud, waste, and abuse. The OIG recommends that HHS work more closely with the Office of Federal Procurement Policy (OFPP) on protecting the integrity of federal grant programs.
- Ensuring the safety of food, drugs, and medical devices. The OIG identifies counterfeit drugs, off-label drug use, and unsanitary conditions at compounding drug and food manufacturing facilities as significant public safety threats. The OIG recommends that HHS issue rules and guidance for fully implementing the Food and Drug Administration Safety and Innovation Act (FDASIA).
New on the list this year are:
- The meaningful and secure exchange and use of electronic health information. According to the OIG, health care providers are missing opportunities to improve patient care and to increase efficiency by exchanging electronic health information with other providers.
- Ensuring effective financial and administrative management. The OIG recommends that HHS leverage technology to further prevent improper payments and to ensure responsible program management by increasing education efforts for providers, grantees, staff, contractors, and other partners.
- Effectively operating public health and human services programs to best serve program beneficiaries. According to the OIG, the threat of communicable diseases such as Ebola demands that HHS uses its resources and expertise to prevent epidemics.
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