By James Swann
Inadequate program integrity contractor oversight and security
vulnerabilities involving health information technology are among the top 10
management challenges facing the Department of Health and Human Services,
according to a memorandum report
from the HHS Office of Inspector General released Nov. 19.
The report, Top Management and Performance Challenges Facing the
Department of Health and Human Services in Fiscal Year 2012, also identified
curbing improper Medicare and Medicaid payments and detecting Medicare and
Medicaid fraud as top challenges.
The Reports Consolidation Act of 2000 requires OIG to submit an annual report
to HHS on top management challenges.
According to the report, program integrity contractors within the Centers for
Medicare & Medicaid Services have often used inadequate data during their
investigations, which has led to potential Medicare and Medicaid
“The integrity contractors rely heavily on data to conduct program integrity
tasks, yet OIG work has found significant limitations in the Medicare and
Medicaid data available to contractors,” the report said.
For example, Medicaid Integrity Contractors rely on claims data from the
Medicaid Statistical Information System to perform their investigations, but OIG
reviews have determined that MSIS data “are not complete, accurate or timely and
do not capture all data elements that can assist in the detection of fraud,
waste and abuse,” the report said.
OIG said CMS has not provided adequate management or oversight of
contractors. However, CMS has made progress in working with its contractors,
including beginning a project to improve MSIS data and increasing the amount of
data it collects on contractor performance, the report said.
In addition to contractor oversight issues, OIG identified problems
associated with implementing HIT, including protecting patient data in
electronic health records.
Although EHRs can benefit patient health by providing a central collection
point for information, they “can also be used to fabricate information,
generating improper payments and corrupting patients' records with inaccurate
and potentially dangerous information,” it said.
HHS has made improvements in protecting patient information contained in
EHRs, such as educating physicians on protecting patient records, but HHS needs
to play a more active role, OIG said.
To help secure EHRs, HHS should “provide additional guidance on information
technology standards and best practices that the health care industry should
adopt for EHRs,” OIG said.
The OIG report said HHS faces numerous challenges in detecting Medicare and
Medicaid fraud. It cited problems with:
effective use of enrollment and payment suspension authorities to deter
fraudulent providers. OIG said CMS should pay close attention to independent
diagnostic testing facilities and comprehensive outpatient rehabilitation
facilities looking to enroll in Medicare, as the two groups have had a history
of not complying with some basic Medicare requirements;
ability to oversee an increased use of data analytics;
maintenance of up-to-date and accurate data;
detection of fraud associated with private plans delivering Medicare and
Medicaid benefits. OIG said CMS should continue to review Medicare Part D and
Medicare Advantage plans to ensure they are meeting program integrity standards;
effective exclusion of individuals and entities from federal health care
OIG also said oversight of the Food and Drug Administration was a top
Previous OIG reviews identified several vulnerabilities within FDA, OIG said,
including inadequate monitoring of drug and device manufacturers to ensure that
products are not being marketed for off-label use.
OIG also said FDA should improve its oversight of drug and device regulatory
“For example, the OIG found weaknesses in FDA's management of internal
scientific disagreements related to regulatory decisions for medical devices
under agency review,” the report said.
OIG said it will continue to evaluate FDA oversight of risk evaluation and
management strategies used by drug and device sponsors.
The OIG Top Management Challenges list is at http://www.hhs.gov/afr/hhs_agency_financial_report_fy_2012-oai.pdf.
Type in “Top Management and Performance Challenges” in the pdf search box to the
find the report.