Safeguarding Medicare, Medicaid and the State Childrens Health Insurance Program from fraudulent and otherwise inaccurate billing tops the list of administrative challenges that the next HHS secretary will face in 2009, according to the agencys inspector generals office, which annually tracks significant management and performance challenges.
Taken together, the three programs account for roughly $611.5 billion in federal spending. The office also identified oversight of Medicares prescription-drug program, quality of care, and emergency preparedness and response as other top priorities.
Improper payments range from reimbursement for services provided but inadequately documented and inadvertent mistakes to outright fraud and abuse, according to the inspector generals report. Controlling fraud in the massive Medicare program has garnered much attention, but is difficult to do in practice. Congressional reports say that Medicare makes about $60 billion a year in payments to unscrupulous billers. In 2007, a joint effort between the Justice Department and HHSthe Health Care Fraud and Abuse Control Programsaid it netted $1.1 billion in returned funds.
Food and Drug Administration oversight and the implementation of health information technology were also identified as other potential challenges. -- by Matthew DoBias