OIG tells CMS to improve hotline responses

The Centers for Medicare and Medicaid Services needs to improve the way its staff and contractor staff process complaints from its waste, fraud and abuse hotline. At the same time, it also needs to upgrade its information systems for processing those complaints, the Department of Health and Human Services Office of the Inspector General said in a review of the effectiveness of the hotline (1-800-HHS-TIPS).

Long timeframes and inefficient processes have delayed starting work on many complaints, the OIG reported. For 58 percent of complaints, the contractors started work within 30 days of CMS's receipt of the complaints from OIG. However, for 29 percent of complaints, contractors took more than four months to start work.

The number of days between the date that a complaint was uploaded from the hotline to the CMS information system and the date that the contractor reported starting work on that complaint ranged from zero (work that was uploaded and started on the same day) to 660 days--with an average of 163 days. On average, more than five months passed between CMS receiving complaints from OIG and contractors beginning work on them.

CMS responded that it concurs with the OIG's recommendation that it improve written guidelines for its staff and contractor staff. Currently, CMS is updating the database to include auditing mechanisms that will enable it to track user activity, contractor assignments and the status of the complaints.

For more details:
- see the OIG report (.pdf)