OIG, HHS disagree on 'incomplete' overpayment reports

The U.S. Health & Human Services Department failed to provide complete quarterly reports in 2010 and can't adequately assess how vulnerable its programs are, according to an Office of Inspector General (OIG) report released Thursday. Although HHS disagreed with OIG's findings, OIG concluded Medicare and Medicaid programs did not follow reporting rules under an executive order aimed at reducing healthcare fraud and waste.

Under Executive Order 13520, the Office of Management and Budget (OMB) is required to identify federal high-priority programs that cost the most improper payments.

OMB found that nine programs are particularly susceptible to many improper payments, OIG said:
- Medicare fee-for-service (Parts A and B)
- Medicare Advantage (Part C)
- Medicare Prescription Drug Benefit (Part D)
- Head Start, administered by the Administration for Children and Families
- Medicaid
- Children's Health Insurance Program
- Foster Care
- Temporary Assistance for Needy Families
- Child Care Development Fund, administered by state agencies

Because HHS didn't have complete reports for all identified high-dollar improper payments that Medicare Parts A, B, C and D paid, OIG couldn't say for sure if the department reported all high-dollar improper payments in general. Therefore, OIG suggested HHS doesn't have the information it needs to determine how at risk each program is and whether they require more oversight.

However, Ellen Murray, HHS assistant secretary for financial resources, responded to Inspector General Daniel Levinson, saying "HHS respectfully disagrees" with the OIG findings. Murray noted that OMB doesn't require HHS must review every available source of potential overpayment and that HHS followed OMB guidance on examining adjusted payments.

HHS and OMB will continue to meet in determining how to implement the executive order, Murray noted.

For more information:
- see the summary and report (.pdf)
- here's the executive order

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