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From Health Law Daily, March 19, 2019

OIG’s FY 2020 budget request seeks $403.2 million to oversee HHS programs

By Jeffrey H. Brochin, J.D.

Justification of Estimates submitted to the Appropriations Committees cites budgetary requirements for meeting OIG’s responsibility to protect the integrity and efficiency of more than a hundred HHS programs.

The HHS Office of Inspector General (OIG) has prepared a budget estimate for fiscal year (FY) 2020 which requests a total of $403.2 million to oversee HHS programs. The sum includes $80 million for oversight of HHS’s Public Health and Human Services (PHHS) programs and $323.2 million for oversight of the Medicare and Medicaid programs, including Health Care Fraud and Abuse Control (HCFAC) Program activities and law enforcement activities coordinated with HHS and the Department of Justice (DOJ) (Fiscal Year 2020 Justification of Estimates for Appropriations Committees, March 18, 2019).

Decreasing costs, increasing efficiency. Inspector General Daniel R. Levinson has submitted the OIG’s estimated HHS budget for FY 2020 in accordance with the Inspector General Act, as amended (5 U.S.C. App.), in which he has defined the OIG’s work as objective, independent, and credible oversight work that identifies opportunities to decrease costs and increase efficiency and effectiveness of HHS programs. The OIG works to hold accountable those who violate federal laws or fail to meet program requirements, and the office deploys data-driven decision making to identify oversight priorities and to produce high-value results.

A history of delivering results. Since its establishment in 1976, the OIG has been at the forefront of combating fraud, waste, and abuse, and has consistently delivered results that strengthen HHS programs and produce substantial returns on investments for taxpayers. For example, in FY 2017, the HCFAC program, in which the OIG is a major participant, returned to the federal government $4 for every $1 invested. Additional examples of OIG’s accomplishments are highlighted in its submission to the Appropriations Committees.

Performance targets. The OIG has set performance targets for the following priority areas: protecting beneficiaries from prescription drug abuse, including opioid abuse; promoting patient safety and accuracy of payments for services furnished in home and community settings; strengthening Medicaid protections against fraud and abuse; and ensuring health and safety of children served by grant-funded programs. Additional key oversight areas include cyber-security, prescription drug pricing, managed care and other value-based healthcare programs, management of grants and contracts, financial stewardship of HHS programs, the Indian Health Service and other programs serving American Indians and Alaska Natives, and HHS’s emergency preparedness and response.

Using data analytics against fraud. The OIG will continue to use the full complement of its oversight tools and authorities to pursue fraud, identify HHS’s most significant risks, and make actionable recommendations to address them. The OIG leverages modern data analytics to identify and target potential fraud schemes and areas of program waste and abuse, and it continues to improve its capabilities to provide high-quality, timely, actionable data to the OIG’s frontline staff, to its government partners, and, where appropriate, to private sector partners. The office will continue to invest in cutting-edge data and technology to support its first-in-class workforce.

Budget justification. The submission noted that HHS is a complex agency with approximately 80,000 employees in the United States and across the globe and is responsible for administering a budget of more than $1 trillion. It is the largest grant-making agency and the fourth-largest contracting agency in the federal government, and administers Medicare and Medicaid, the largest public healthcare programs in the nation. HHS programs deliver important health and human services that touch the lives of virtually every American, and it is therefore essential that those programs operate economically, effectively, and efficiently and are free from fraud, waste, and abuse.

Two main oversight categories. The OIG’s budget request is divided into two main categories: (1) PHHS oversight, and (2) Medicare and Medicaid oversight (Health Care Fraud and Abuse Control (HCFAC) Program). The OIG’s request will continue to optimize resources to advance OIG’s mission, and their budget request includes dedicated resources to continue the OIG’s PHHS oversight work at the FY 2019 enacted level and to continue OIG’s oversight of evolving, complex, and costly HCFAC programs (Medicare and Medicaid), including resources for additional personnel and operational needs.

The OIG will continue to focus strategically on developing a modern workforce and supporting it with tools to ensure that 21st century oversight challenges are successfully addressed, and the investments in HHS’s OIG will advance President Trump’s Management Agenda by fostering transformational change and paving the way for sustained improvement over time through greater efficiency, effectiveness, transparency, and accountability.

MainStory: TopStory AgencyDocuments CMSNews FraudNews

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