Health Reform WK-EDGE GAO nudges HHS on 54 open oversight improvement recommendations
Monday, April 15, 2019

GAO nudges HHS on 54 open oversight improvement recommendations

By Victoria Moran, J.D., M.H.A.

Medicare, Medicaid, and premium tax credits are among the list of open priority recommendations made by the U.S. Government Accountability Office (GAO) aiming to improve HHS programs, operations, and achieve costs savings.

In a letter to the HHS Secretary, the GAO laid out 54 open recommendations that it believes should be given high priority and implemented. The recommendations address high-risk areas like Medicare and Medicaid, health information technology, food safety oversight, Indian health services, opioids, health insurance tax credits, and oversight of federal awards and grants (GAO Report, GAO-19-364SP, March 28, 2019).

What are priority recommendations? GAO believes that implementing priority recommendations will improve operations, including monetary savings, and "eliminating mismanagement, fraud, and abuse; or making progress toward addressing a High Risk or duplication issue." The office highlights these recommendations in order to garner the attention from the heads of specific government departments or agencies. In a November 2018 report, the GAO reported that government agencies had implemented 77 percent of GAO’s recommendations made in the last four years; HHS had implemented 75 percent.

In the recent letter to HHS, the GAO identified 54 priority recommendations that HHS should implement; 42 priority recommendations were made in a prior April 2018 letter by the GAO and 12 recommendations are new.

The recommendations. The priority recommendations are categorized into ten groups; the numbers in parentheses represent the number of open priority recommendations.


Medicare (9). The GAO notes that the Medicare program is one of the highest risks facing the government with the aging population and growth in per capita health care costs. The nine open priority recommendations address steps to improve CMS’s payment policy and design.


Medicaid (10). Medicaid is another high risk facing the government and the second largest health program. Implementing the ten open priority recommendations would help CMS track critical incidents involving Medicaid beneficiaries and improve oversight, accountability, and transparency of spending including though demonstrations.


Medicare and Medicaid improper payments (8). According to the GAO, Medicare and Medicaid program improper payments are "unacceptably high" at over $84 billion in 2018. With spending only expected to increase, the eight open priority recommendations suggest using guidance, assessment, collaboration, and claims reviews to address payment issues.


Health information technology (4). Cybersecurity threats to healthcare infrastructure are growing, and recent data breaches serve as a reminder of the significance of securing healthcare information, including beneficiary data. The four open priority recommendations provide steps to ensure effective monitoring of electronic health record programs and progression towards goals; adopting cybersecurity processes and procedures to protect Medicare beneficiary data from external entities; and ensure progress towards implementing IT enhancements to establish the electronic public health situation awareness network.


FDA oversight (5). These five open priority recommendations focus on ensuring the safety of products and food imported into the United States. This is particularly important since about 80 percent of active pharmaceutical ingredients manufacturers are located outside of the U.S.


Indian Health Service health care (2). Today’s American Indians and Alaska Natives have a life expectancy that is 5.5 years lower than other races in the U.S. and they are dying at higher rates from preventable causes. They also continue to have issues accessing health care services. The two open priority recommendations address quality and timeliness of services provided by the Indian Health Service.


Opioid use disorders (3). The three open priority recommendations aim to help HHS evaluate efforts to expand medication-assisted treatment (behavioral therapy combined with medication) to treat opioid addiction. The recommendations also seek to gather data on opioid prescribing patterns and ensure implementation of recommendations to address neonatal abstinence syndrome (a withdrawal condition affecting babies).


Public Health Service Act programs (2). The two priority recommendations would help to assure HHS that covered entities are complying with requirements under the 340B Drug Pricing Program and Medicaid Drug Rebate Program and that manufacturers are not at risk of mistakenly providing duplicate discounts for Medicaid prescriptions.


Health insurance premium tax credit payment integrity and enrollment controls (9). The nine open priority recommendations focus on allowing HHS to improve its oversight of the premium tax credit established under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). Aside from improved oversight the recommendations aim to monitor costs, risk, and program performance; assist with tax compliance; enhance the eligibility determination process; improve customer service related to submitting eligibility documentation; improve documentation of agency activities; and reduce improper premium tax credit payments.


Oversight of federal awards and research grants (2). Implementing the two open priority recommendations would assist HHS in effective oversight of federal funds it awards and help to ensure the workload and costs for complying with requirements to receive university research funding are not overly burdensome.

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