Catherine Boerner (cboerner@boernerconsultingllc.com) President of Boerner Consulting LLC, New Berlin, WI.
The 2020 Top Management and Performance Challenges Facing HHS is an annual publication of the U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG).[1] It is a good resource to review.
It is interesting to see, over the past four years, how the challenges have changed in terms of the order they are listed. “Safeguarding Public Health” obviously rose to the top in 2020. Table 1 shows the past two years.
2019 Top Management and Performance Challenges Facing HHS Overview |
2020 Top Management and Performance Challenges Facing HHS Overview |
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1. Ensuring the Financial Integrity of HHS Programs |
1. Safeguarding Public Health |
2. Delivering Value, Quality, and Improved Outcomes in Medicare and Medicaid |
2. Ensuring the Financial Integrity of HHS Programs |
3. Protecting the Health and Safety of HHS Beneficiaries |
3. Delivering Value, Quality, and Improved Outcomes in Medicare and Medicaid |
4. Safeguarding Public Health |
4. Protecting the Health and Safety of HHS Beneficiaries |
5. Harnessing Data to Improve Health and Well-Being of Individuals |
5. Harnessing Data To Improve Health and Well-Being of Individuals |
6. Working Across Government to Provide Better Service to HHS Beneficiaries |
6. Improving Collaboration To Better Serve Our Nation |
The report[2] explains that:
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“Medicare expenditures totaled $796 billion in 2019. The Federal Medicaid budget totaled $411.3 billion in FY 2019 (with an additional $17.5 billion for CHIP [Children’s Health Insurance Program]).”
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“HHS’s Medicare program is the Nation’s largest health insurer by expenditures, handling more than 1 billion claims per year.”
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“Reducing improper payments—such as payments to ineligible recipients or duplicate payments—is critical to safeguarding Federal funds.
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“Due to their size, HHS programs account for some of the largest estimated improper payments in the Federal government. Medicare and Medicaid accounted for 59 percent, or $103.6 billion [emphasis added], of all governmentwide estimated improper payments reported in FY 2019.”
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“Furthermore, insufficient HHS oversight of grant programs and contracts poses risks of significant improper payments.”
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“Notably, the Medicare FFS [fee-for-service] improper payment rate estimate decreased from 8.1 percent ($31.6 billion) in FY 2018 to 7.3 percent ($28.9 billion) [emphasis added] in FY 2019.”
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“However, some types of providers and suppliers pose heightened risk to the financial security of Medicare. For instance, OIG and CMS have identified especially high rates of improper payments for home health, hospice, and SNF [skilled nursing facility] care; durable medical equipment (DME); chiropractic services; and certain hospital services.”