Budget cuts compromise HHS OIG's anti-fraud capabilities
American Academy of Sleep Medicine
Wednesday, July 31, 2013
According to a report from the Center for Public Integrity, the Office of Inspector General of the U.S. Department of Health & Human Services will be significantly restricted in its ability to monitor and address Medicare and Medicaid fraud and abuse within the nation's health care system in the coming years.
Citing budget and staffing cuts and hiring freezes, an OIG document obtained by the Center states, "As OIG's budget resources decline, so do our enforcement and oversight activities," adding that it "will not be able to keep pace" with the expected jump in taxpayer-subsidized health care under the Affordable Care Act, "maintain/expand our highly successful Medicare Fraud Strike Forces, or keep pace with the expected need for growth to combat ongoing health care fraud."
The HHS OIG will delay an unspecified number of investigations into hospitals identified for providing poor quality care, according to the document, citing "significantly reduced" travel budgets and the high cost to hire experts to review medical files. The document warns that the delay might result in a "potentially high-risk hospital not being reviewed" and "potentially erroneous claims not being reviewed."
Other projects that HHS OIG planned for 2013 but have been canceled include:
• An audit of computer systems security for the ACA insurance exchanges;
• An investigation of nursing homes to determine possible overuse of controversial antipsychotic treatments;
• An analysis of efforts by state governments and Medicaid managed care groups to uncover fraud and abuse;
• A probe of pharmaceutical drugs that are being marketed under the Medicare Part D program without FDA's clearance for safety and effectiveness; and
• An investigation into fraudulent suppliers of high-cost durable medical equipment.