In its 2014 annual report, the OIG has noted the following challenges for HHS:
- Implementing, Operating, and Overseeing the Health Insurance Marketplaces. Specifically, payments of premiums, eligibility, and security.
- Ensuring Appropriate Use of Prescription Drugs in Medicare and Medicaid focusing on Utilization and Billing Patterns. Medicare paid $32 million for HIV drugs for beneficiaries with questionable utilization patterns in 2012. In 2014 the OIG found claims on behalf of many beneficiaries with no indication of HIV in their Medicare histories, claims for excessive doses or supplies of HIV drugs, claims for HIV drugs from a high number of pharmacies or prescribers, or claims for contraindicated drugs. GAO believes these beneficiaries are receiving inappropriate prescription drugs and selling them illegally, pharmacies are billing for drugs that beneficiaries never received, or that beneficiaries’ Medicare identification numbers were stolen.
- Protecting an Expanding Medicaid Program From Fraud, Waste, and Abuse, including avoiding or recovering Medicaid improper payments; ensuring access to care in Medicaid managed care programs; and curbing state Medicaid policies that inflate federal costs.
- Fighting Waste and Fraud and Promoting Value in Medicare Parts A and B by durable medical equipment (DME) suppliers, home health agencies, community mental health centers, clinical laboratories, ambulance transportation suppliers, and outpatient therapy providers.” The joint Health Care Fraud and Abuse Program, which has recovered $8 for every $1 invested. CMS reported an error rate of 10.1 percent for Medicare fee for service (Parts A and B), an estimated $36 billion in improper payments in FY 2013. Additionally, OIG noted that Medicare pays significantly more for services performed in an outpatient hospital department than for the same services performed in an ambulatory surgical center (ASC). Medicare could save billions of dollars by paying for hospital outpatient services at ASC rates.
- Ensuring Quality in Nursing Home, Hospice, and Home- and Community-Based Care.
- The Meaningful and Secure Exchange and Use of Electronic Health Information, including achieving interoperability of EHRs, and keeping sensitive health information secure.
- Effectively Operating Public Health and Human Services Programs To Best Serve Program Beneficiaries.
- Ensuring Effective Financial and Administrative Management.
- Protecting HHS Grants and Contract Funds From Fraud, Waste, and Abuse.
- Ensuring the Safety of Food, Drugs, and Medical Devices.
Full report at: http://oig.hhs.gov/reports-and-publications/top-challenges/2014/2014-tmc.pdf
via Marilyn Singleton, MD, JD @MSingletonMDJD
