Kusserow’s Corner: OIG Lists 2013 Top Management and Performance Challenges

The HHS Office of Inspector General (OIG) annually prepares a summary of the most significant management and performance challenges facing the HHS, referred to as the Top Management Challenges (TMC). The TMC reflects continuing vulnerabilities that the OIG has identified for HHS over recent years, as well as new and emerging issues that HHS will face in the coming year. This summary fulfills the OIG’s requirement under the Reports Consolidation Act of 2000, Public Law 106-531 to identify management challenges, assess HHS’s progress in addressing each challenge, and submit this statement to HHS annually.

The assessment is included as an appendix to the publicly available HHS annual Agency Financial Report.

  1. Overseeing the Health Insurance Marketplace.
  2. Transition to Value Based Payments for Health Care.
  3. Ensuring Appropriate Use of Prescription Drugs in Medicare and Medicaid.
  4. Protecting Integrity of Expanding Medicaid Program.
  5. Fighting Fraud and Waste in Medicare Part A and B.
  6. Preventing Improper Payment and Fraud in Medicare Advantage.
  7. Ensuring Quality of Care in Nursing Facilities and Home and Community Based Settings.
  8. Effectively Using Data and Technology to Protect Program Integrity.
  9. Protecting HHS Grants and Contract Funds from Fraud, Waste, and Abuse.
  10. Ensuring safety of Food, Drugs, and Medical Devices.

Of particular interest is the ensuring the accuracy of payments made to insurers through the Affordable Care Act’s health insurance exchanges. The OIG says CMS would have to coordinate with health insurers to ensure that payments are both accurate and timely. It also says HHS should evaluate the risk associated with exchange payments and if necessary calculate error rates associated with the payments.

Secretary Sebelius Calls on OIG to Conduct Expedited Review of the Failure of the Healthcare.com Launch

Kathleen Sebelius, HHS Secretary asks the OIG to conduct an expedited review of the implementation and launch of the HealthCare.gov website. She stated that the launch of the Healthcare.gov website was not acceptable; “accordingly, I am requesting your office undertake a review of our contractors, and management of and payments to those contractors, in the development of Healthcare.com…I welcome your findings, and commit to full cooperation with your review so we can gain a full understanding of what led to the failed launch of Healthcare.gov, and take concrete action to avoid such problems in the future.”.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2013 Strategic Management Services, LLC. Published with permission.