Health Care Fraud and Abuse Control Program: Results of Review of Annual Reports for Fiscal Years 2002 and 2003
Highlights
Because of the susceptibility of health care programs to fraud and abuse, Congress enacted the Health Care Fraud and Abuse Control (HCFAC) program as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Pub. L. No. 104-191. HIPAA requires that the Departments of Health and Human Services (HHS) and Justice (DOJ) issue a joint annual report to Congress on amounts deposited to the Federal Hospital Insurance Trust Fund and amounts appropriated from the trust fund for the HCFAC program. It also requires GAO to submit reports biennially. This, our final report required by law, provides the results of our review of amounts reported as (1) deposits to the trust fund, (2) appropriations from the trust fund and justification for expenditure of such amounts by HHS and DOJ, and (3) savings resulting from expenditures from the trust fund. We also report on the repeated late issuance of the annual HCFAC report as well as the status of our prior recommendations.
Recommendations
Recommendations for Executive Action
Agency Affected | Recommendation | Status |
---|---|---|
Department of Health and Human Services | To improve HHS's accountability over HCFAC program expenditures, the HHS Inspector General should require all HHS/OIG components to develop procedures for ensuring that all key staff hours spent on HCFAC activities are recorded in OIG workload tracking systems. |
Closed – Implemented
The two primary HHS/OIG components involved in HCFAC work--the Office of Investigations (OI) and the Office of Evaluation & Inspections (OEI)--took action to implement the recommendation. In June 2003, OI updated its procedures to help ensure that all key staff hours spent on HCFAC activities are recorded in the workload system. OI Policies and Procedures Manual (OIPPM) includes policies and procedures related to reporting requirements under the Health Insurance Portability and Accountability Act. OIPPM requires OI staff to complete and submit timesheets in a timely manner, and instructs OI staff to report their time as Direct Time under the appropriate OI file number. OIPPM also requires OI managers to examine timesheets to check time usage for reasonableness and consistency. Further, adherence to timekeeping requirements has been included as elements in the Performance Plans of both supervisory and non-supervisory employees of OI. Finally, periodic OI internal inspections include reviews for compliance with timekeeping requirements. In March 2009, OEI updated its procedures for filling out all the information in the OEI's management information system, including completion of timesheets. The procedures instruct OEI employees to record their time to specific inspection numbers. The procedures also contain instructions for managers relating to reviewing their staff's time recorded in the system.
|
Department of Justice | To improve DOJ's accountability for HCFAC program expenditures, the Attorney General should develop monitoring procedures to ensure that DOJ components record key HCFAC program expenditure data under the appropriate HCFAC account class in DOJ's accounting system. |
Closed – Implemented
According to DOJ, headquarters components and district offices are responsible for monitoring obligations and expenditures of their HCFAC funds. At the beginning of each fiscal year, HCFAC funds are allocated to DOJ components and district offices. Each component establishes an operating plan for HCFAC program costs. Throughout the year, the components monitor obligations and expenditures of these funds by reviewing Expenditure and Allotment reports from the department's Financial Management Information System (FMIS). The components can also generate reports from FMIS with detailed transaction data. Components review these reports on a regular basis to verify that HCFAC obligations and expenditures are correctly reflected in FMIS. For the district offices, the Executive Office for the United States Attorneys (EOUSA) notifies them by e-mail of the amount of their HCFAC allocation for the year and funds control policies and procedures. The district offices are to prepare an operating plan each year and ensure, among other things, that obligations of HFAC funds are reviewed monthly for accuracy and completeness.
|
Department of Health and Human Services | To help ensure that the joint HHS and DOJ HCFAC reports are issued in a more timely manner, the Secretary of HHS and the Attorney General should develop a more expedited review process. |
Closed – Implemented
DOJ has taken steps to expedite the review process for the annual HCFAC report to Congress. According to DOJ, it has decreased the time needed to provide narrative information for the report by providing a time line of action items, responsible parties, and due dates to the responsible parties through the Health Care Fraud Working Group. The status of the annual HCFAC report has been included in the agenda of the Working Group's bi-weekly meetings. However, even with these procedures in place, the January report deadline has proved to be unrealistic for DOJ because of the process for receiving and reconciling information on amounts collected. DOJ must collect data from 93 judicial districts across the country. With the large numbers of multi-defendant and multi-district cases, DOJ must eliminate duplications and generate accurate total figures. Once reconciled internally, the data is then cross-checked with data from the OIG and from the Medicare Hospital Insurance Trust Fund. This process has been a chief reason for the delay in issuing the HCFAC report. Also, according to DOJ, since the recommendations were made, the Consolidated Debt Collection System has been implemented and should streamline gathering and reconciling health care collection data. DOJ believes that extending the deadline for issuing the HCFAC report to June would provide sufficient time to address the data gathering issues. According to DOJ, it concurs with HHS's proposal to change the reporting deadline for the joint HCFAC report from January to June. HHS included in its budget submissions for fiscal year 2009 and 2010 a recommendation that the deadline for issuing the HCFAC report be extended to June. According to HHS, this request will be repeated in future budget submissions.
|
Department of Justice | To help ensure that the joint HHS and DOJ HCFAC reports are issued in a more timely manner, the Secretary of HHS and the Attorney General should develop a more expedited review process. |
Closed – Implemented
HHS has taken steps to expedite the review process for the annual HCFAC report. According to HHS/OIG, a process was developed that permits HHS to complete the initial draft of the report and transmit it to DOJ before the end of the calendar year, generally by early December. However, even with these improved procedures in place, HHS/OIG stated that the reporting deadline under HIPAA has still proved to be unrealistic. HHS and DOJ have not been able to prepare a meaningful report in the 3 months allotted by HIPAA, especially considering the number of reporting entities involved in both DOJ and HHS. However, DOJ must collect data from 93 judicial districts across the country, and then eliminate duplications to generate accurate total figures. The data is then cross-checked with data from the OIG and from the Medicare Hospital Insurance Trust Fund. HHS was advised by DOJ that this process of receiving and reconciling collection figures has been a chief reason for delay in issuance of the HCFAC report. HHS included in its budget submissions for fiscal year 2009 and 2010 a recommendation that the deadline for issuing the HCFAC report be extended to June. This request will be repeated in future budget submissions.
|
Department of Justice | To help ensure that the joint HHS and DOJ HCFAC reports are issued in a more timely manner, the Secretary of HHS and the Attorney General should notify congressional committees with oversight responsibility for the HCFAC program of delays in issuing the joint report within 1 month after missing the January 1 deadline and provide updates until the report is issued. |
Closed – Not Implemented
According to HHS, HHS did not concur with this recommendation, and accordingly, no formal notifications were made.
|
Department of Health and Human Services | To help ensure that the joint HHS and DOJ HCFAC reports are issued in a more timely manner, the Secretary of HHS and the Attorney General should notify congressional committees with oversight responsibility for the HCFAC program of delays in issuing the joint report within 1 month after missing the January 1 deadline and provide updates until the report is issued. |
Closed – Not Implemented
In its official agency comments included in GAO's HCFAC report (GAO-05-134), DOJ stated it does not concur with this recommendation. In May 2009, DOJ reiterated its nonconcurrence.
|