The Government Accountability Office (GAO) published a report highlighting the important role oversight and law enforcement agencies play in eliminating fraud, waste, and abuse.
The report found “more than $300 million in duplicative IT systems at three different government agencies, including the U.S. Department of Health & Human Services–which has six duplicative systems costing $256 million alone,” reported FierceHealthIT. The six potentially duplicative investments at HHS include four investments that support enterprise information security and two for Medicare coverage determination, according to GAO.
“With so much money on the line, it is critical that our government agencies are doing everything possible to save taxpayer money,” Sen. Tom Carper (D-Del.), chairman of the Senate’s Homeland Security Committee, said in a statement. “An important part of this effort is to ensure that we are not investing in programs that unnecessarily overlap or are duplicative.”
In January 2013, GAO, the Council of the Inspectors General on Integrity and Efficiency, and the Recovery Accountability and Transparency Board convened a forum with the purpose of exploring ways in which oversight and law enforcement agencies use data analytics to assist in the prevention and detection of fraud, waste, and abuse, as well as identifying the most-significant challenges to realizing the potential of data analytics and actions that the government can take to address these challenges. HHS OIG played a significant role in helping plan and conduct this forum.
The report summarizes the key themes that emerged from the discussion in the forum. Specifically, the report discusses the challenges and opportunities in (1) accessing and using data and (2) sharing data. In addition, participants identified next steps to address these challenges and capitalize on opportunities.
Though participants pointed to the Center for Medicare & Medicaid Services’ (CMS) Fraud Prevention System as an example of harnessing data through predictive modeling and other analytics, the report says of government efforts overall, that “despite these efforts, the path to capitalizing on the potential of data analytics is not a clear one.”
Participants said they’re not always aware of all the data sources available for addressing fraud, that they’d like to see a database of known offenders and also pointed out that government program offices lack incentives to develop IT systems useful in oversight efforts, reported FierceHealthIT. They cited other challenges including:
- An overwhelming amount of available data and difficulties setting priorities
- The various legal implications of owning and maintaining data, including an array of regulations such as Freedom of Information Act disclosure requirements, HIPAA and others
- Difficulty measuring the success of analytics programs
Participants also said that federal and state government agencies are not working from a single set of data standards, which makes integrating systems and interpreting the various data elements difficult. Among the lessons learned, participants said that:
- Having analytics tools isn’t enough; it’s crucial to have well-trained staff to perform data analysis, identify high-quality investigative leads and areas of greatest risk
- Building support for analytics from top management down also is essential
- Data and analytics operations must be consolidated into one location to enhance effectiveness and return on investment
- Parties responsible for retaining and maintaining databases must be identified to ensure proper safeguards are in place to protect privacy
The forum proposed actions including:
- Addressing statutory challenges related to data access and use
- Developing an ongoing community of practice focused on data-sharing challenges
- Compiling a library of available open-source data analytics, modules, and tools
HHS officials disagreed that its information security investments were duplicative, but nonetheless plan to review them this month to “identify opportunities for consolidation.” As for the Medicare coverage determination investments? HHS officials noted that they have “consolidated several functions but could not provide documented justification for why the other functions were not consolidated.”