The United States Department of Health and Human Services (HHS) is responsible for protecting the health of all Americans and providing essential human services.
HHS is made up of 10 operating divisions with nearly 80,000 employees.
Department of Health and Human Services
“The American healthcare system is broken. Decades of government mismanagement and over-regulation have encouraged waste, fraud, and inefficiency, which may benefit the healthcare industrial complex, but harms patients and taxpayers in the long run.” - Tom Coburn
A Path Forward
The Department of Health and Human Services manages almost a quarter of all federal outlays, including Medicare, totalling over $1 trillion. Unfortunately, programs like Medicare have been on GAO’s high risk list since before many Millennials today were born “due to its size, complexity, and susceptibility to mismanagement and improper payments.” The Affordable Care Act has also had its issues with mismanagement and improper payments.
HHS oversees the National Institutes of Health that has a budget of over $32 billion. However, the NIH has been criticized for a lack of prioritization when it comes to funding certain research projects. For example, the NIH funded a study that gave swedish massages to rabbits while the NIH director said an Ebola vaccine could have been found sooner if not for the stagnant funding the agency received.
There are areas within the HHS that can be cleaned up without harming any necessities in Federal programs like improper payments and unnecessary overhead expenses. Streamlining our nation’s healthcare agency will not only be better for patients, but for taxpayers’ wallets.
1.1 Trillion Annual Budget
Eric D. Hargan Secretary
80,000 Government Employees
Budget Growth 2012 - 2016
$3.53 Trillion
Annual budget for the federal government
$1.1 Trillion
Percentage of Federal Budget
Oversight Reports
Medicare Paying Twice for the Same Services
Implementation of New Rates May Lead to Billions in Excess Payments
Three Areas of Risk that Contribute to Medicaid Spending Growth
340B Drug Program Lacking Oversight
CDC Off Center
Lack of Data, Evaluations, and Public Reporting Strains Usefulness of $100 Billion Medicaid Demonstration Projects
Medicare Continues to Make Payments for ‘Medically Unnecessary’ Services
Medicare and Medicaid: CMS Needs to Fully Align Its Antifraud Efforts with the Fraud Risk Framework
Further Action Needed to Expedite Use of National Data for Program Oversight
Health Insurance Exchanges: Changes in Plans and Premiums Effect Automatic Re-enrollment Consumers’ Costs
HHS OIG: HHS Did Not Identify and Report Antideficiency Act Violations
HHS OIG: HHS Did Not Identify and Report Antideficiency Act Violations
HHS OIG: Compendium of Unimplemented Recommendations
GAO: Grants Management: Actions Needed to Address Persistent Grant Closeout Timeliness and Undisbursed Balance Issues
HHS OIG: Compendium of Unimplemented Recommendations
GAO: Grants Management: Actions Needed to Address Persistent Grant Closeout Timeliness and Undisbursed Balance Issues
HHS OIG: HHS Agencies Did Not Accurately Report Some Conference Costs For Fiscal Year 2012
GAO: Health Care Fraud: Information on Most Common Schemes and the Likely Effect of Smart Cards
HHS OIG: 2015 Top Management & Performance Challenges
OFFICE OF INSPECTOR GENERAL
HHS OIG: Mildmay Uganda Did Not Always Manage the President’s Emergency Plan for AIDS Relief Funds in Accordance With Award Requirements
HHS OIG: Medicare Could Save Millions by Strengthening Billing Requirements for Canceled Elective Surgeries
HHS OIG: Medicare Improperly Paid Millions of Dollars for Prescription Drugs Provided to Incarcerated Beneficiaries During 2006 Through 2010
HHS OIG: Medicare Improperly Paid Providers Millions of Dollars for Entitlement-Terminated Beneficiaries Who Received Services During 2010 Through 2012
HHS OIG: The Fraud Prevention System Identified Millions in Medicare Savings, but the Department Could Strengthen Savings Data by Improving Its Procedures
HHS OIG: CMS Made Payments Associated With Providers After Referring Individual Providers’ Debts to the Department of the Treasury for Collection
HHS OIG: CMS’s Internal Controls Did Not Effectively Ensure the Accuracy of Aggregate Financial Assistance Payments Made to Qualified Health Plan Issuers Under the Affordable Care Act
HHS OIG: CMS Could Not Effectively Ensure That Advance Premium Tax Credit Payments Made Under the Affordable Care Act Were Only for Enrollees Who Paid Their Premiums
HHS OIG: Medicare Did Not Pay Selected Inpatient Claims for Bone Marrow and Stem Cell Transplant Procedures in Accordance With Medicare Requirements
HHS OIG: Opportunities for Program Improvements Related to States’ Withdrawals of Federal Medicaid Funds
HHS OIG: Hospices Inappropriately Billed Medicare Over $250 Million for General Inpatient Care
HHS OIG: Incomplete and Inaccurate Licensure Data Allowed Some Suppliers in Round 2 of the Durable Medical Equipment Competitive Bidding Program That Did Not Have Required Licenses
HHS OIG: HHS OIG’s Latest Fiscal Year 2015 Improper Payment Review
HHS OIG: Hundreds of Millions in Medicare Payments for Chiropractic Services Did Not Comply With Medicare Requirements
GAO: Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments That Did Not Comply With Federal Requirements
HHS OIG: Medicare Inappropriately Paid Acute-Care Hospitals for Outpatient Services They Provided to Beneficiaries Who Were Inpatients of Other Facilities
HHS OIG: The Centers for Medicare & Medicaid Services Could Improve Performance Measures Associated With the Fraud Prevention System
HHS OIG: The Centers for Disease Control and Prevention Did Not Award President’s Emergency Plan for AIDS Relief Funds for 2013 in Compliance With Applicable HHS Policies
HHS OIG: CMS Did Not Provide Effective Oversight To Ensure That State Marketplaces Always Properly Determined Individuals’ Eligibility for Qualified Health Plans and Insurance Affordability Programs
Government Accountability Office
GAO: NIH Chimpanzee Management Program: Consolidation Should Achieve Cost Savings, but a Clear Implementation Plan Is Needed
GAO: Medicare Program Integrity: Greater Prepayment Control Efforts Could Increase Savings and Better Ensure Proper Payment
GAO: Medicaid: CMS Should Ensure That States Clearly Report Overpayments
GAO: Prescription Drugs: Comparison of DOD, Medicaid, and Medicare Part D Retail Reimbursement Prices
GAO: Medicaid: Information on Inmate Eligibility and Federal Costs for Allowable Services
GAO: Medicare Program Integrity: CMS Pursues Many Practices to Address Prescription Drug Fraud, Waste, and Abuse
GAO: Medicaid: A Small Share of Enrollees Consistently Accounted for a Large Share of Expenditures
GAO: Medicaid: Additional Actions Needed to Help Improve Provider and Beneficiary Fraud Controls
GAO: Medicaid Demonstrations: Approval Criteria and Documentation Need to Show How Spending Furthers Medicaid Objectives
GAO: Medicaid and insurance Exchanges: Additional Federal Controls Needed to Minimize Potential for Gaps and Duplication in Coverage
GAO: Medicaid Demonstrations: Approval Criteria and Documentation Need to Show How Spending Furthers Medicaid Objectives
GAO: Medicaid Program Integrity: Improved Guidance Needed to Better Support Efforts to Screen Managed Care Providers
GAO: Medicare: Claim Review Programs Could Be Improved with Additional Prepayment Reviews and Better Data
GAO: Medicare Advantage: Fundamental Improvements Needed in CMS’s Effort to Recover Substantial Amounts of Improper Payments
GAO: Medicare Advantage: Action Needed to Ensure Appropriate Payments for Veterans and Nonveterans
GAO: Medicare: Opportunities Exist to Recover Potential Overpayments to Providers with Criminal Backgrounds
GAO: Medicare Part B Drugs: Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals
GAO: Medicare Advantage: Fundamental Improvements Needed in CMS’s Effort to Recover Substantial Amounts of Improper Payments
GAO: Medicare Advantage: Limited Progress Made to Validate Encounter Data Used to Ensure Proper Payments
GAO: Medicaid: CMS Has Taken Steps, but Further Efforts Are Needed to Control Improper Payments
GAO: Medicare Provider Education: Oversight of Efforts to Reduce Improper Billing Needs Improvement
GAO: Medicaid Program Integrity: CMS Should Build on Current Oversight Efforts by Further Enhancing Collaboration with States
GAO: Medicaid Demonstrations: Federal Action Needed to Improve Oversight of Spending
GAO: Medicare Advantage: CMS Should Use Data on Disenrollment and Beneficiary Health Status to Strengthen Oversight
GAO: Hospital Value-Based Purchasing: CMS Should Take Steps to Ensure Lower Quality Hospitals Do Not Qualify for Bonuses
GAO: CMS Should Evaluate Providing Coverage for Disposable Medical Devices That Could Substitute for Durable Medical Equipment
GAO: Improper Payments: Improvements Needed in CMS and IRS Controls over Health Insurance Premium Tax Credit
GAO: CMS’s Efforts to Ensure Proper Payments and Identify and Recover Improper Payments
GAO: Drug Discount Program: Update on Agency Efforts to Improve 340B Program Oversight
GAO: CMS: Analysis of Contracting Data
GAO: CMS Fraud Prevention System Uses Claims Analysis to Address Fraud
GAO: Indian Health Service: Capping Payment Rates for Nonhospital Services Could Save Millions of Dollars for Contract Health Services
GAO: Generic Drug User Fees: Application Review Times Declined, but FDA Should Develop a Plan for Administering Its Unobligated User Fees
GAO: Use of Special Interest Projects to Fund Prevention Research Centers
GAO: PPACA: CMS Should Act to Strengthen Enrollment Controls and Manage Fraud Risk
GAO: Healthcare.gov: Actions Needed to Enhance Information Security and Privacy Controls
GAO: ACA: Concentration, Plan Availability and Premiums, and Enrollee Experiences in Health Insurance Markets Since 2014
GAO: State Health-Insurance Marketplaces: Three States Used Varied Data Sources for Eligibility and Had Few Indications of Potentially Improper Enrollments
GAO: IRS Should Mitigate Limitations of Data to Be Used for the Age and Gender Adjustment for the Tax on High-cost Health Plans
Office of Inspector General
HHS OIG: Obstacles to Collection of Millions in Medicare Overpayments
HHS OIG: Early Alert: The Food and Drug Administration Does Not Have an Efficient and Effective Food Recall Initiation Process
HHS OIG: HealthCare.gov: Case Study of CMS Management of the Federal Marketplace
Department of Justice
HHS OIG: Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2015