Observations on HEW's Controls over Sterilizations in Region III

The administrative controls established by the Department of Health, Education, and Welfare (HEW) to assure compliance with its sterilization requirements were examined at HEW Region III. The controls established in Pennsylvania seemed to be working, and no flagrant sterilization abuse was found. However, the following problems were identified: statistical reporting was inaccurate; HEW was lax in seeing that States used consent documents that complied with its regulations in Medicaid programs; administrative controls and payment procedures for Medicaid need to be strengthened to ensure that requirements are met for sterilizations done in conjunction with a related surgical procedure; in Pennsylvania, consent documents for 10 of 129 approved Medicaid physician claims reviewed omitted one element of informed consent; and Pennsylvania had not established adequate procedures to ensure that hospital and physician Medicaid claims were both denied when requirements were not met. HEW might consider the following matters when developing and implementing new sterilization regulations: seeing that grantees promptly use approved forms for documenting informed consent, ensuring that records for all HEW-funded sterilizations can be easily obtained and reviewed, seeing that criteria for sterilization claim denial are understood and consistently implemented by reviewers, and improving the accuracy of statistical reporting of sterilization activity.