WASHINGTON – The U.S. Department of Health and Human Services needs to strengthen its oversight capacity, according to the Office of Inspector General’s annual summary of management and performance challenges facing the agency.
Every year, OIG identifies for HHS the most significant new and emerging challenges the department faces and reflects on continuing challenges. For 2011, OIG’s Top Management Challenges include:
- Implementing the Affordable Care Act. The ACA is sprawling and far-reaching. HHS and its partners “must be vigilant in identifying and addressing existing and emerging fraud, waste and abuse risk areas in ACA-related programs.”
- Preventing and detecting Medicare and Medicaid fraud. HHS must strengthen the enrollment system, be attentive to the programs’ vulnerabilities and carefully select its contractors and make sure they have what they need to appropriately handle the job they have been given.
- Identifying and reducing improper payments. HHS needs to continue to monitor its payments systems and prepayment reviews and to develop error rates for additional programs as well as expand its education efforts.
- Patient safety and quality of care. The department should continue to prioritize quality of care and patient safety by implementing more of the quality improvements of the ACA and the goals set by the Partnership for Patients.
- Integrity and security of information systems and data. Protecting the electronically stored personal medical information of patients must be a priority. HHS needs to close security vulnerabilities that could potentially allow unauthorized access to personal data.
- Availability and quality of data for effective program oversight. To ensure the availability and completeness of data, HHS needs to address the vulnerabilities of the databases it relies on and then form a process that will ensure the completeness and correctness of the data.
- Oversight of the Centers for Medicare & Medicaid program and benefit integrity contractors. HHS must strengthen oversight and monitoring of its contractors.
- Ensuring integrity in Medicare and Medicaid benefits delivered from private plans. HHS must strengthen its oversight of bids and risk adjustment payments, monitor plans’ implementation of integrity safeguards, provision of covered services and compliance with marketing rules.
- Avoiding waste in healthcare pricing methodologies. HHS must put into place a process that makes sure Medicare and Medicaid payments are economical as well as in line with changes taking place in the marketplace.
- Grants management and administration of contract funds. HHS must vigilantly monitor and manage new and continuing grant programs.
- Ensuring the safety of the nation’s food supply. HHS and the Food and Drug Administration need to act quickly to implement the Food Safety Modernization Act to better protect the country’s food supply.
- Oversight of the approval, safety and marketing of drugs and devices. HHS must close vulnerabilities in the FDA’s oversight of drug safety, biologics and medical devices by focusing on reducing off-label promotion and using its authority to sanction those engaged in fraud and abuse.
- Oversight and enforcement of HHS’ ethics programs. HHS should do more to identify and address conflicts of interest among internal and external stakeholders.
To read OIG's full assessment, click here.
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Stephanie Bouchard
Managing Editor of Healthcare Finance News
