HHS inspector general puts insurance exchanges on his agenda

Daniel Levinson heads HHS' Office of the Inspector General and is chief watchdog for fraud and abuse in Medicare and Medicaid, overseeing 1,500 employees. An attorney, Levinson previously served as deputy general counsel for the U.S. Office of Personnel Management, general counsel for the U.S. Consumer Product Safety Commission, chairman of the U.S. Merit Systems Protection Board, and inspector general for the U.S. General Services Administration. Modern Healthcare reporter Joe Carlson recently spoke with Levinson about the agency's priorities in investigating the use of electronic health records, billing in Medicare's prescription drug program and his office's changing budget for staffing. This is an edited excerpt.

Modern Healthcare: Why are investigators so interested in potential fraud and abuse related to what physicians are doing on their personal electronic health-record screens as far as cutting and pasting text from a template or from someone else's medical record and putting it into a new record?

Daniel Levinson: That's all part of our attempts to ensure there is appropriate accuracy with respect to billing. There is certainly the potential for abuse in cutting and pasting. There are also some real efficiencies that can occur as well. So we're taking a very sophisticated approach toward understanding where the possible vulnerabilities are in that kind of practice.

MH: Is your office watching how the federal incentive payments to providers to install EHR systems are being spent?

Levinson: It's high on our list.

MH: What about watching the Medicare Part D drug benefit program in terms of preventing waste, fraud and abuse.

Levinson: Part D continues to be an increasingly significant part of the menu of issues that we deal with, and we are going to be looking at all aspects of the transactional work that occurs in Part D.

MH: There have been a series of audits into hospitals looking at a number of standard measures and areas where many hospitals trip up in their billing. What is the status of that effort?

Levinson: That's an ongoing process.

MH: Are budget changes affecting your office's staffing and workload?

Levinson: Some of the supplemental funding that we had received early on with the Affordable Care Act no longer exists, and as a result we've not been able to replace people who have retired, so our workforce is not quite as large as it was a couple of years ago. That said, because of the recent budget passage, we have been able to stabilize our funding. We received a significant increase in our so-called discretionary funding, a lot of which will go to bolstering our oversight of the Affordable Care Act. But overall we retain a very experienced and solid workforce.

MH: What are the Affordable Care Act areas of activity that are going to be increasing?

Levinson: We are focusing especially on the insurance marketplaces to ensure payment accuracy, look at eligibility and examine the contracts since the contractors have played an important part in building, and hopefully fixing and maintaining the system that underpins the marketplaces. We'll be looking at contract planning, acquisition, contract management and performance.

MH: What about Medicare fraud and abuse?

Levinson: We're continuing to devote as many resources as we can to our anti-fraud efforts in the cities that we've had significant task force successes in places like South Florida, Houston and Los Angeles. We're doing important work with the CMS in looking at some of the demonstration and pilot programs on improving quality and efficiency, trying to understand how these new designs can be most effective within the context of our anti-fraud laws.