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Indian Health and Human Services

This webpage offers an overview of the Office of Inspector General's (OIG) body of work as it relates to the Indian health and human services.

Planned Work

  • The COVID-19 pandemic has disproportionately affected American Indian and Alaska Native (AI/AN) populations nationwide. The Centers for Disease Control and Prevention (CDC) reported that the age-adjusted AI/AN population's mortality rate from COVID-19 was 1.8 times higher than that among non-Hispanic whites as of December 2020. The Indian Health Service (IHS) has issued its COVID-19 Pandemic Vaccine Plan detailing how the IHS health care system will distribute, allocate, and administer the COVID-19 vaccine. The CDC recommended that all jurisdictions be prepared to immediately vaccinate identified critical populations as the earliest COVID-19 vaccine doses became available and were granted emergency use authorization. IHS is recognized as a "coordinator," similar to a State or other jurisdiction, for vaccine distribution. Tribal Health Programs and Urban Indian Organizations had the option to receive vaccines through either the IHS or their State. IHS direct facilities receive the vaccine through IHS. Approximately 338 facilities elected to receive vaccines through the IHS (including IHS direct facilities, Tribal Health Programs, and Urban Indian Organizations). We will focus on IHS's coordination of the distribution, allocation, and administration of the vaccine to Tribal Health Programs. Read the Work Plan Summary
  • The Indian Health Service (IHS) is charged with providing comprehensive health care for approximately 2.6 million American Indians and Alaska Natives (AI/ANs). It is critical to ensure safe and accessible health care for AI/ANs during the COVID-19 pandemic. Prior OIG work found that IHS facilities often lack sufficient clinical and other staff, and identified numerous problems caused by staffing shortages, including limited patient access to specialists and problems with the use of contracted staff. The COVID-19 pandemic may exacerbate staffing shortages as IHS and Tribal hospitals continue to see more COVID-19 patients. As a response, IHS contracted additional staff by forming a Critical Care Response Team pilot program, which is designed to provide urgent medical care for COVID-19 patients in facilities with insufficient staffing. The teams are also charged with preparing and training frontline health care staff on evidence-based and best practices, supporting clinical decision making, and providing consultations and advice on hospital operations and how to manage critically ill patients. As of September 29, 2020, IHS had deployed five teams to provide services at six IHS-operated facilities and three tribally operated facilities and planned to make the program a longer-term part of IHS operations. Doing so could help remedy longstanding staffing shortages at IHS facilities. However, problems identified in prior OIG work indicate that IHS may have difficulty managing this contracted resource and integrating the teams into facility practices. OIG's review will use interviews with IHS and contracted staff, as well as document reviews, to assess IHS use of the Critical Care Response Teams, including development, management, and oversight of the teams, and IHS selection criteria for determining which facilities would receive deployments. Read the Work Plan Summary
  • The Families First Coronavirus Response Act provided $64 million in additional resources for COVID-19 response activities through the Indian Health Service (IHS) and requires coverage, without cost-sharing, for COVID-19 testing for American Indians/Alaska Natives, who receive health services. The Paycheck Protection Program and Health Care Enhancement Act provided $750 million for COVID-19 testing and testing-related services through IHS. From these two Acts, funding for COVID-19 testing to urban Indian organizations total $53 million and funding to IHS Federal health programs and Tribal health programs total $611 million. We will audit IHS's allocation and utilization of funding to urban Indian organizations, IHS Federal health programs and Tribal health programs. Specifically, our objectives will be to determine whether: (1) IHS allocated the COVID-19 funds to ensure that testing supplies were available to meet community needs, and (2) COVID-19 funds were used by IHS and grantees for testing, including other testing-related services, in accordance with Federal requirements. Read the Work Plan Summary
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) has awarded a series of grants to combat opioid use disorder. These grants include State Targeted Response to the Opioid Crisis grants (Opioid STR) with approximately half of $970 million awarded in fiscal year (FY) 2017 and the other half awarded in FY 2018. In FY 2018, SAMHSA also awarded more than $930 million in the State Opioid Response grants (SOR) and approximately $50 million in Tribal Opioid Response grants (TOR). The purpose of the Opioid STR, SOR, and TOR grants are to increase access to treatment, reduce unmet treatment need, and reduce opioid overdose related deaths. This post-award audit will determine how select States or Tribal agencies implemented programs under the Opioid STR, SOR, or TOR grants. We will also determine whether the activities of these agencies and subrecipients responsible for implementing the programs complied with Federal regulations and met grant program goals. Read the Work Plan Summary
  • The Indian Health Service's (IHS's) mission is to partner with American Indians and Alaska Natives to elevate their physical, mental, social, and spiritual health to the highest level. The goal of IHS is to ensure that comprehensive, culturally acceptable personal and public health services are available and accessible to all of the approximately 2.6 million members of the 573 federally recognized Tribes. In 1975, Congress recognized the importance of Tribal decision making in Tribal affairs and the nation-to-nation relationship between the United States and Tribes through the passage of the Indian Self-Determination and Education Assistance Act (ISDEAA) (P.L. No. 93-638). Under ISDEAA, federally recognized Tribes administer their own healthcare programs and services that IHS would otherwise provide through P.L. No. 93-638 funding agreements with IHS. In 2019, a pediatrician who worked at several IHS health facilities during a 21-year period was convicted of sexually abusing children served at these facilities. Congressional officials have expressed concerns about safeguards for Indian children and specifically about IHS failing to address this pediatrician's history of offenses at the various IHS health facilities where he was employed. The Indian Child Protection and Family Violence Prevention Act (P. L. No. 101-630), requires background checks, including Federal Bureau of Investigation fingerprinting, for employees whose job duties involve contact with children. Prior OIG audit work identified two Tribal health facilities that did not meet Federal requirements for background verifications for employees in contact with children. We will determine whether the tribally operated health facilities met Federal and Tribal requirements for background verification of employees, contractors, and volunteers in contact with children served by the facilities. Read the Work Plan Summary

  • The Federal government pays its share of a State's Medicaid expenditures based on the Federal Medical Assistance Percentage (FMAP), which varies depending on the State's relative per capita income. States' regular FMAPs range from a low of 50 percent to a high of 83 percent; however, States receive a 100-percent FMAP for expenditures related to services received through Indian Health Service (IHS) facilities. In Federal fiscal years 2016 through 2018, States claimed $6.6 billion in expenditures at the IHS services FMAP, all of which was federally funded. We will analyze selected States' methodologies for identifying expenditures claimed at the IHS services FMAP and determine whether the States claimed these expenditures in accordance with Federal requirements. Read the Work Plan Summary

  • IHS provides a comprehensive health service delivery system for approximately 2 million American Indians and Alaska Natives either by operating health facilities directly or by funding tribes through contracts or compacts to operate health facilities themselves. In certain cases, tribes may operate a facility known as a Federally Qualified Health Center (FQHC), which is certified by CMS to provide outpatient health services to rural areas or underserved populations. In addition to funding from IHS, the tribes may also receive health care funding from the Medicaid or Medicare programs. This report will build on OIG’s body of work identifying longstanding challenges that likely impact the quality of health care services provided to American Indians and Alaska Natives. We will review a tribally operated FQHC that is funded by IHS, to determine whether health services delivered to American Indians and Alaska Natives met applicable Federal requirements. Read the Work Plan Summary

Related Reports

Report Date
Although the Bemidji Area Office Had Adequate Procedures To Disburse Indian Health Service Funds, It Needs To Strengthen Its Procedures for Monitoring the Use of the Funds A-05-18-00019 02/18/2021
Choctaw Nation of Oklahoma Made Progress Toward Meeting Program Goals During the First Year of Its Tribal Opioid Response Grant A-07-20-04121 01/20/2021
Indian Health Service Facilities Made Progress Incorporating Patient Protection Policies, but Challenges Remain OEI-06-19-00331 12/17/2020
Instances of IHS Labor and Delivery Care Not Following National Clinical Guidelines or Best Practices OEI-06-19-00190 12/10/2020
Incidence of Adverse Events in Indian Health Service Hospitals OEI-06-17-00530 12/10/2020
Few Patients Received High Amounts of Opioids from IHS-Run Pharmacies OEI-05-18-00470 12/09/2020
Tribal Health Programs: Concerns About Background Verifications for Staff Working With Indian Children A-01-20-01500 08/28/2020
Most Indian Health Service Purchased/Referred Care Program Claims Were Not Reviewed, Approved, and Paid in Accordance With Federal Requirements A-03-16-03002 04/10/2020
Seminole Nation of Oklahoma Did Not Adequately Operate And Manage Its Head Start Program A-06-18-07002 12/18/2019
Indian Health Service Has Strengthened Patient Protection Policies but Must Fully Integrate Them Into Practice and Organizational Culture OEI-06-19-00330 12/18/2019
Organizational Challenges to Improving Quality of Care in Indian Health Service Hospitals (OEI-06-16-00390) 08/27/2019
The Administration for Children and Families Should Improve the Oversight of Tribal Grantees' Low-Income Home Energy Assistance Programs (A-07-17-04105) 08/20/2019
Case Study: Indian Health Service Management of Rosebud Hospital Emergency Department Closure and Reopening (OEI-06-17-00270) 07/17/2019
IHS Needs To Improve Oversight of Its Hospitals' Opioid Prescribing and Dispensing Practices and Consider Centralizing Its Information Technology Functions (A-18-17-11400) 07/17/2019
The Passamaquoddy Tribe's Pleasant Point Health Center Needs To Improve Its Medical-Referral Process (A-01-17-01503) 03/29/2019
The Penobscot Indian Nation Did Not Meet All Federal and Tribal Health and Safety Requirements (A-01-17-01502) 11/26/2018
The Fort Peck Assiniboine and Sioux Tribes Improperly Administered Some Low-Income Home Energy Assistance Program Funds for Fiscal Years 2011 Through 2015 (A-07-18-04106) 08/21/2018
The Passamaquoddy Tribe's Pleasant Point Health Center Did Not Always Meet Federal and Tribal Health and Safety Requirements (A-01-17-01500) 07/30/2018
The Indian Health Service's Controls Were Not Effective in Ensuring That Its Purchase Card Program Complied With Federal Requirements and Its Own Policy (A-07-16-05090) 07/05/2018
The Indian Health Service's Controls Were Not Effective in Ensuring That Its Travel Card Program Complied With Federal Requirements and Its Own Policy (A-07-16-05091) 04/12/2018
The Turtle Mountain Band of Chippewa Indians Improperly Administered Some Low-Income Home Energy Assistance Program Funds for Fiscal Years 2010 Through 2013 (A-07-16-04233) 09/27/2017
The Administration for Children and Families Did Not Always Resolve American Indian and Alaska Native Head Start Grantees' Single Audit Findings in Accordance With Federal Requirements (A-06-17-07003) 12/14/2017
Two Indian Health Service Hospitals Had System Security and Physical Controls for Prescription Drug and Opioid Dispensing but Could Still Improve Controls (A-18-16-30540) 11/28/2017
The Three Affiliated Tribes Improperly Administered Low-Income Home Energy Assistance Program Funds for Fiscal Years 2010 Through 2014 (A-07-16-04230) 07/13/2017
Indian Health Service Hospitals: More Monitoring Needed to Ensure Quality Care (OEI-06-14-00010) 10/6/2016
Indian Health Service Hospitals: Longstanding Challenges Warrant Focused Attention to Support Quality Care (OEI-06-14-00011) 10/6/2016
Expenses Incurred by the Rocky Boy Health Board Were Not Always Allowable or Adequately Supported (A-07-15-04221) 3/22/2016
OIG Site Visits to Indian Health Service Hospitals in the Billings, Montana Area (OEI-09-13-00280) 8/14/2015
Access to Mental Health Services at Indian Health Service and Tribal Facilities (OEI-09-08-00580) 9/30/2011
Access to Kidney Dialysis Services at Indian Health Service and Tribal Facilities (OEI-09-08-00581) 9/30/2011
Audit of the Indian Health Service’s Internal Controls Over Monitoring of Recipients’ Compliance With Requirements of the Loan Repayment Program (A-09-10-01005) 12/29/2010
Results of Limited Scope Review of Sisseton-Wahpeton Oyate Head Start Program (A-07-09-03134) 6/15/2010
Results of Limited Scope Review at the Confederated Tribes and Bands of the Yakama Nation's Head Start Program (A-09-09-00099) 3/2/2010
Audit of the Mashantucket Pequot Tribal Nation's Use of Federal Discount Drug Programs (A-01-99-01502) 8/17/2000