Recently the U.S. Department of Health & Human Services Office of Inspector General issued a report on its “key focus areas” until at least 2018. In the Strategic Plan, Daniel R. Levinson, the U.S. Department of Health and Human Services’ Inspector General, focuses on four goals: (1) Fight Fraud, Waste, and Abuse; (2) Promote Quality, Safety, and Value; (3) Secure the Future; and (4) Advance Excellence and Innovation. The Strategic Plan also highlights key strategies and indicators for attaining and measuring results, and will be updated as needed.
Selected highlights from the Strategic Plan:
I. Fighting Fraud, Waste, and Abuse
Priority: Identify, investigate, and take action when needed
Strategy: OIG uses data analysis and risk assessments of emerging issues to identify suspected fraud, waste, and abuse and deploy oversight and enforcement resources. OIG investigations result in criminal convictions and penalties, civil settlements, and administrative actions against those who commit fraud. Updates on OIG’s enforcement actions are available on their website.
Key focus areas include: Medicare and Medicaid program integrity and waste in HHS programs. OIG will also continue implementing and refining protocols for self-disclosure of wrongdoing.
Priority: Hold wrongdoers accountable and maximize recovery of public funds
Strategy: OIG partners with the Department of Justice (DOJ) and HHS on Medicare Fraud Strike Force teams and other health care fraud enforcement activities through the Health Care Fraud and Abuse Control (HCFAC) program. On average, the HCFAC program recovers more than $7 for every $1 invested and protects programs through nonmonetary results, such as criminal convictions and exclusions of providers from participation in Federal health care programs. The latest HCFAC results are available in the annual HCFAC Report to Congress. OIG will continue to pursue all appropriate means to hold fraud perpetrators accountable and to recover stolen or misspent HHS funds.
Key focus areas include: identifying and recovering improper payments and utilizing exclusions and referrals for debarment to protect HHS programs and beneficiaries.
Priority: Prevent and deter fraud, waste, and abuse
Strategy: OIG identifies fraud, waste, and abuse vulnerabilities in HHS programs and operations and advises HHS program administrators and policymakers on how to implement effective safeguards. For example, OIG’s recommendations for strengthening HHS program administration and grants management and OIG grant fraud prevention training for HHS are summarized on the OIG website. OIG also educate health care providers and provide them tools to help prevent fraud and abuse.
Key focus areas include: promoting compliance with Federal requirements and resolving noncompliance; advising HHS on key safeguards to prevent fraud, waste, and abuse, and assessing whether providers and suppliers, grantees, and others are qualified to participate in Government programs.
II. Promote Quality, Safety, and Value
Priority: Foster high quality of care
Strategy: OIG will continue to evaluate and recommend improvements to the systems intended to promote quality of care, exemplified by OIG’s series of reviews of adverse events (patient harm resulting from medical care), available on the OIG website. OIG will also investigate and refer for prosecution cases involving abuse or grossly deficient care of Medicare or Medicaid patients. Looking ahead, OIG plans to expand its portfolio of work on quality of care.
Key focus areas include: promoting quality of care in nursing facilities and home- and community-based settings, access to and use of preventive care, and quality improvement programs.
Priority: Promote public safety
Strategy: OIG recommends improvements to HHS programs to ensure adequate emergency preparedness and response; to protect the safety of food, drugs, and medical devices; and to ensure that their grantees (e.g., Head Start and child care providers) meet safety standards. OIG will continue to prioritize fraud investigations that have public safety as well as financial implications and to look for comprehensive solutions. For example, OIG will continue to investigate prescription drug fraud cases and plan to work with leadership across HHS operating divisions to identify systemic solutions for this problem.
Priority: Maximize value by improving efficiency and effectiveness
Strategy: OIG’s findings and recommendations promote efficiency and effectiveness in specific programs and across HHS. OIG will also work to ensure that HHS programs do not overpay for services or products relative to their value in the marketplace. Looking ahead, OIG also plans to assess programs intended to achieve value through care coordination and new ways of delivering and paying for care, as well as the reliability and integrity of quality, outcomes, and performance data.
III. Secure the Future
Priority: Foster sound financial stewardship and reduction of improper payments
Strategy: OIG reviews HHS’s annual financial statement audits and error rate reports. OIG also conduct targeted reviews to identify improper payments to be recovered and recommend management improvements to systemic weaknesses that contribute to improper payments. For example, OIG’s series of hospital audits identified common billing and payment errors and recommended fixes and recoveries of funds that were overbilled to the Government (overpayments).
OIG will continue to prioritize work on billing and payment errors by providers, effective program administration and contract oversight, and inefficiencies that result in wasteful spending.
Priority: Support a high-performing health care system
Strategy: OIG is working to support a high-performing health care system to foster better health outcomes and lower costs. OIG’s efforts include promoting quality, coordination, and efficiency. OIG provides technical assistance on safeguards to protect new and changing systems and programs from fraud, waste, and abuse. As HHS manages the transition to payments based on value rather than volume, OIG plans to conduct reviews and recommend changes to maximize overall value, protect program integrity, and foster value and high performance.
Priority: Promote the secure and effective use of data and technology
Strategy: Data and technology promise to drive improvements in health care and human services at lower costs. OIG will continue to advise program administrators and policymakers on promoting the secure and effective use of data and technology.
Looking ahead, key focus areas include: the accuracy and completeness of program data (e.g., Medicaid data), the privacy and security of personally identifiable information, and the security and integrity of electronic health records.
IV. Advance Excellence and Innovation
Priority: Recruit, retain, and empower a diverse workforce
Strategy: OIG achieves its mission through its workforce. To identify, understand, and address the challenges facing HHS, OIG will continue to invest in its workforce by recruiting and retaining talented employees and by maintaining workforce excellence and the highest standards of professional conduct.
Priority: Leverage leading-edge tools and technology
Strategy: OIG maximizes the returns on its investments by leveraging data analytics and technology to inform decisions about where to best direct resources. For example, analysis of Medicare billing patterns has guided OIG’s decisions about where to deploy Medicare Fraud Strike Force teams and data analysis helps OIG to uncover fraud and conspiracies in specific cases, such as those highlighted in OIG’s Semiannual Report to Congress.
Priority: Promote leadership, vision, and expertise
Strategy: In an evolving health and human services landscape, OIG focuses on building leadership and expertise to drive positive change. OIG’s multidisciplinary approach affords it a range of tools to develop sound and innovative solutions. As HHS programs, technology, and the environment change, embracing innovation will help OIG maintain relevance and achieve impact.