HHS Inspector General to lawmakers: Not enough agents to take on fraud cases
In testimony this week before the United States House Committee on Energy and Commerce Subcommittee on Oversight and Investigation, Inspector General Christi A. Grimm says serious fraud, waste, and abuse continue to threaten Department of Health and Human Services (HHS) programs and the people they serve.
The Office of Inspector General is turning down hundreds of viable criminal and civil health care fraud cases each year because the agency doesn’t have enough agents to work cases or enough auditors, data scientists, and analysts to detect trends, outliers, and program vulnerabilities.
Grimm said in written testimony to the committee that OIG’s regional offices reviewed and evaluated more than 1,780 hotline complaints in fiscal year 2021 and more than 3,562 in fiscal year 2022 that might have developed into viable cases, but they didn’t have the resources to open additional cases. Indeed, last year the OIG turned down nearly 650 cases from the major case coordination it has with the Centers for Medicare & Medicaid Services (CMS), a nearly 10-percent increase in the percentage of cases declined from the prior year.
“These uninvestigated cases represent real, potential unchecked fraud and the potential for patients to be put in harm’s way,” Grimm told the committee.
Although the OIG is addressing cases of serious fraud and abuse, Grimm said the agency doesn’t have enough resources to keep up with the level of threat to HHS, patients, and taxpayer dollars. “Every day we make tough choices on cases and issues to decline,” she said. “For example, we have declined referrals from the Drug Enforcement Administration for cases tied to the opioid epidemic, including allegations of a physician providing medically unnecessary prescriptions that led to overdose deaths, and hospice fraud cases involving patients receiving false diagnoses of terminal illnesses for which hospice providers received millions of dollars in reimbursement. OIG’s agents and digital investigators are in high demand by prosecutors for their unparalleled expertise in HHS’ complex health care programs and the fraud schemes that exploit them.”
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Grimm said that President Bident’s fiscal year 2024 budget includes $52.5 million in additional funding for resources for OIG that, if enacted, would address this shortfall, particularly fraud, waste and abuse in Medicare and Medicaid. “Current funding allows OIG to audit and evaluate only a small portion of HHS grant outlays and limits our ability to hold wrongdoers accountable,” she said. “Our work consistently demonstrates that rigorous oversight uncovers where HHS’ awarding process and its awards are improperly managed, funds are misspent, and health and safety are put at unnecessary risk. The size of HHS grants programs underscores the urgency of uncovering and sealing gaps in integrity.”
White House reportedly set to nominate Bertagnolli to lead NIH
Monica M. Bertagnolli, M.D., director of the National Cancer Institute, will be tapped to lead the National Institutes of Health, according to the Washington Post. The publication said the White House plans to nominate the Boston cancer surgeon to fill the position. The federal agency has not had a permanent director since December 2021 when Francis S. Collins stepped down. Since then, NIH Administrator Lawrence A. Tabak has served as acting director. Dr. Bertagnolli graduated from Princeton University with a Bachelor of Science in Engineering degree and attended medical school at the University of Utah. She trained in surgery at Brigham and Women’s Hospital and was a research fellow in tumor immunology at the Dana-Farber Cancer Institute. As director of the National Cancer Institute, she recently developed the National Cancer Plan, which aims to reduce cancer death rates and achieve President Biden’s cancer moonshot initiative goals.
HHS makes hospice, home health ownership data publicly available
HHS has announced it will release ownership data for all Medicare-certified hospice and home health agencies, which will allow anyone to review detailed information on the ownership of more than 6,000 hospices and 11,000 home health agencies certified to participate in the Medicare program on the CMS website. The information includes the organization’s name, type, practice location addresses, National Provider Identifier, CMS Certification Number; detailed information about each owner such as whether it is an organization or an individual and whether it is a direct owner or indirect owner (that is, there is at least one subsidiary between it and the provider); and a numerical associate ID for each owner to enable linkage to the enrollment file. Additional files that include data on mergers, acquisitions, consolidations, and changes of ownership since 2016 for hospices and home health agencies enrolled in Medicare are also available as part of this release. CMS said it expects to release updated hospice and home health ownership data every quarter in a searchable format on data.cms.gov, in addition to a flat Excel file available for download to make it easier for researchers to use.
HHS releases resources to address cybersecurity concerns in health and public health sector
To address concerns of cyber threats, HHS has released the following resources for the health care and public health sector:
- Knowledge on Demand–a new online educational platform that offers free cybersecurity trainings for health and public health organizations to improve cybersecurity awareness. “Cyberattacks are one of the biggest threats facing our health care system today, and the best defense is prevention,” said Deputy Secretary Andrea Palm in the announcement. “These trainings will serve as an asset to any sized organization looking to train staff in basic cybersecurity awareness and are offered free of charge, ensuring that those hospitals and health care organizations most vulnerable to attack can take steps toward resilience. This is part of HHS’s continued commitment to working with hospitals, Congress, and industry leaders in protecting America’s patients."
- Health Industry Cybersecurity Practices (HICP) 2023 Edition–a publication that aims to raise awareness of cybersecurity risks, provide best practices, and help set standards in mitigating the most pertinent cybersecurity threats. “Staying current and responsive to evolving cyber threats is critical to protecting patient safety. HICP 2023 is the updated version that our industry needs to make sure they are applying scarce resources to the highest threat. This will give the most underserved hospitals the best return on investment for cyber investment,” said Erik Decker, vice president and chief information security officer of Intermountain Health and chair of the Health Sector Coordinating Council Cybersecurity Working Group, Salt Lake City.
- Hospital Cyber Resiliency Initiative Landscape Analysis–a report on domestic hospitals’ current state of cybersecurity preparedness, including a review of participating hospitals benchmarked against standard cybersecurity guidelines such as HICP 2023 and the National Institute of Standards and Technology Cybersecurity Framework. “The Hospital Cyber Resiliency Initiative Landscape Analysis greatly furthers our understanding of hospital cyber resiliency and provides us with a platform to begin working through potential policy considerations and minimum standards to better support cybersecurity in U.S. hospitals. We look forward to working with hospitals, Congress, and the information security community as we look to improve cyber resiliency and protect patient safety and wellbeing.” said Palm.