Health Law Daily OIG’s top challenges include opioids and program integrity oversight
Monday, November 19, 2018

OIG’s top challenges include opioids and program integrity oversight

By Bryant Storm, J.D.

The top twelve performance challenges facing the HHS Office of Inspector General (OIG) in 2018 focus on the opioid crisis, the integrity of the federal health care programs, and ensuring the safety and quality of health care services. The challenges cover multiple HHS programs, from Medicare and Medicaid to food, drug, and medical device safety. The top twelve challenges highlight areas of focus for the OIG’s more than $1 trillion portfolio (OIG Report, November 19, 2018).

The challenges. The OIG report describes each of the twelve challenges, highlighting the key components of the challenge and what the OIG is doing to tackle the issue.

Preventing and Treating Opioid Misuse. The OIG is focused on reducing inappropriate prescribing, fraud, diversion, and other misuse of opioids. On average, 134 individuals died from opioid-related deaths in the U.S. each day in 2017. The OIG is seeking to curb the crisis by implementing prescriber education and monitoring tools.

Ensuring Program Integrity in Medicare Fee-for-Service and Effective Administration of Medicare. Oversight efforts for this challenge include reducing improper payments, combating fraud, fostering prudent payment policies, and maximizing the promise of health information technology.

Ensuring Program Integrity and Effective Administration of Medicaid. The OIG will focus its Medicaid oversight efforts by improving the reliability of national Medicaid data, reducing improper payments, combating fraud, and ensuring appropriate Medicaid eligibility determinations.

Ensuring Value and Integrity in Managed Care and Other Innovative Healthcare Payment and Service Delivery Models. In this area, the OIG will focus on ensuring effectiveness and integrity in new models, combatting provider fraud and abuse, and fostering compliance by managed care organizations.

Protecting the Health and Safety of Vulnerable Populations. Key components of this challenge include ensuring the safety and security of unaccompanied children in HHS care, addressing substandard nursing home care, reducing problems in hospice care, mitigating risks to individuals receiving home- and community-based services, ensuring access to safe and appropriate services for children, and addressing serious mental illness.

Improving Financial and Administrative Management and Reducing Improper Payments. To combat improper payments, the OIG will focus on addressing weaknesses in financial management systems, addressing Medicare trust fund issues/social insurance, and improving contract management.

Protecting the Integrity of HHS Grants. To protect over $100 billion in grants, the OIG will focus on ensuring appropriate and effective use of grant funds, ensuring effective grant management at the department level, ensuring program integrity and financial capability at the grantee level, and combating fraud, waste, and abuse.

Ensuring the Safety of Food, Drugs, and Medical Devices. Key components of this challenge include Ensuring the safety, effectiveness, and quality of drugs and medical devices and ensuring the security of drug supply chain.

Ensuring Quality and Integrity in Programs Serving American Indian/Alaska Native Populations. The OIG will focus on addressing deficiencies in IHS management, infrastructure, and quality of care while preventing fraud and misuse of HHS funds serving American Indian and Alaska Native populations.

Protecting HHS Data, Systems, and Beneficiaries from Cybersecurity Threats. To combat data challenges, the OIG will focus on securing HHS’s data and systems and advancing cybersecurity within the health care ecosystem.

Ensuring that HHS Prescription Drug Programs Work as Intended. The OIG will work towards protecting the integrity of prescription drug programs, fostering prudent payments for prescription drugs, and ensuring appropriate access to prescription drugs.

Ensuring Effective Preparation and Response to Public Health Emergencies. To address public health emergencies, the OIG will focus on ensuring access to health and human services during and after emergencies, ensuring effective use and oversight of funding, and ensuring effective and timely responses to infectious disease threats.

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