OIG Outlines Top 10 HHS Challenges

Priorities include fighting the opioid crisis, protecting children, and partnering with states on Medicaid integrity.

The HHS Office of Inspector General (OIG) released its annual list Wednesday of the biggest obstacles and opportunities facing the department.

The report, Top Management and Performance Challenges Facing HHS, outlines 10 categories and makes the case that department personnel should keep these topics in mind as they seek “to reimagine HHS as part of the Federal Government’s comprehensive plan” for reform.

The list includes some familiar themes and highlights four priority areas: fighting opioid and prescription drug abuse, protecting children, preventing fraud and inappropriate payments in home-based services, and partnering with states on Medicaid.

Here are the 10 major items OIG identified, with brief summaries:

1. Ensuring program integrity in Medicare — The trust fund for Medicare Part A, known as hospital insurance, is on course to be depleted by 2029, according to this year’s annual report from the Medicare Board of Trustees. Spending for Medicare Part B, known as medical insurance, is expected to grow nearly 7% over the next five years, outpacing growth of the overall economy. In order to keep Medicare financially viable, the department must fight fraud, reduce improper payments, capitalize on information technology, and take other measures, the report states.
    
2. Ensuring program integrity in Medicaid — Counting federal and state programs, Medicaid spent $574 billion in Fiscal Year 2016, serving nearly 69 million enrollees, more than any other federal program. Surmounting the challenges related to Medicaid will require additional partnership and cooperation between states and the federal government; that should include fraud prevention tools, fiscal controls, and better national data management, the OIG states.
    
3. Curbing the opioid epidemic — The OIG report identifies five things HHS should do to help fight the nation’s opioid crisis. Those include addressing apparently high rates of inappropriate opioid prescriptions among Medicare patients, cracking down on fraud and diversion, knocking down barriers to treatment when possible, holding grant recipients accountable for how their funds are used, and fighting fraud among those providing treatment for opioid use disorder.

4. Improving care for vulnerable populations — In addition to elderly patients in nursing homes and hospice care, HHS programs serve vulnerable groups that include children from low-income families in foster care, and others receiving home and community-based services. The department hasn’t always taken action when nursing homes, for example, have been found to be deficient, and that needs to change, the report states.
    
5. Ensuring integrity in managed care and other programs delivered through private insurers — Private insurance companies and sponsors provide coverage to millions of Americans enrolled in HHS programs. That can make it difficult for HHS to ensure that the programs are operating properly, so the department should take steps to fight fraud and waste, the OIG states.
    
6. Improving financial and administrative management and reducing improper payments — As the federal government’s largest civilian agency, HHS had about $1.1 trillion in budgetary resources in Fiscal Year 2016. Even so, the department has suffered from weaknesses in its financial management systems and problems with improper payments.
    
7. Protecting the integrity of public health and human services grants — Recently passed legislation expanded HHS grant programs by billions of dollars. Given the increase, the department should employ additional safeguards to ensure that the recipients are using the money properly and effectively, the OIG report states.
    
8. Ensuring the safety of food, drugs, and medical devices — The FDA oversees more than 13,000 drug facilities and 25,000 facilities for medical devices, according to FDA data cited in the OIG report. More should be done to better fulfill the duties of this role and to conduct oversight of the medical device and drug supply chains, the report states.
    
9. Ensuring program integrity and quality in programs serving American Indian and Alaska Native populations — Of all the federal funds that went to American Indian and Alaska Native communities last year, 45%, or $7 billion, came from HHS. Despite the large budget, HHS has a hard time ensuring that crucial services are being delivered consistently and free from fraud, waste, or abuse, the report states.
    
10. Protecting HHS data, systems, and beneficiaries from cybersecurity threats — The department deals with a large and quickly growing amount of data necessary to its work, and those data are spread across many different places and among various public and private entities with varying degrees of cybersecurity know-how and resources. This is why HHS should take steps to protect its own data and seek to foster a cybersecurity culture beyond the department, the OIG report states.