Pension & Benefits News GAO nudges HHS on 54 open oversight improvement recommendations
Tuesday, April 23, 2019

GAO nudges HHS on 54 open oversight improvement recommendations

By Pension and Benefits Editorial Staff

In a letter to the Department of Health and Human Services (HHS) Secretary, the Government Accountability Office (GAO) laid out 54 open recommendations that it believes should be given high priority and implemented. The recommendations address high-risk areas like Medicare, health information technology, and health insurance tax credits, among others.

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. Some of the recommendations are as follows:

  • Medicare. 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.
  • Improper payments. 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. Cybersecurity threats to health care infrastructure are growing, and recent data breaches serve as a reminder of the significance of securing health care 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.
  • Health insurance premium tax credit payment integrity and enrollment controls. 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). 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.

SOURCE: GAO Report, GAO-19-364SP, March 28, 2019

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