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U.S. Department of Health and Human Services Met Many Requirements of the Improper Payments Information Act of 2002 but Did Not Fully Comply for Fiscal Year 2017

Issued on  | Posted on  | Report number: A-17-18-52000

Report Materials

The Office of Inspector General (OIG) must review the Department of Health and Human Services (HHS) compliance with the Improper Payments Information Act of 2002 (IPIA; P.L. No. 107-300) as amended by the Improper Payments Elimination and Recovery Act of 2010 (P.L. No. 111-204) and the Improper Payments Elimination and Recovery Improvement Act of 2012 (IPERIA; P.L. No. 112-248). Ernst & Young (EY), LLP, under its contract with the HHS OIG, audited the fiscal year 2017 HHS improper payment information reported in the Agency Financial Report (AFR) to determine compliance with IPIA and related guidance from the Office of Management and Budget (OMB).

EY determined HHS met many requirements but did not fully comply with IPIA. Among the items required for compliance with IPIA, EY determined HHS published the AFR for fiscal year (FY) 2017, conducted risk assessments for 24 programs deemed not susceptible to improper payments and determined the programs were not at risk for them, published corrective action plans for seven of the eight programs OMB deemed susceptible to significant improper payments and two programs deemed susceptible to significant improper payment under the Disaster Relief Appropriations Act (DRAA) (P.L. No. 113-2) that had not expended all funds by FY 2017. EY also determined that HHS published and met annual reduction targets for four of the seven programs for which it reported reduction targets in the FY 2016 AFR and reported an improper payment rate of less than 10 percent for six of the eight programs OMB deemed susceptible to significant improper payments and two programs under DRAA that had not expended all funds by FY 2017.

EY concluded that HHS did not comply with several IPIA requirements. EY found HHS did not report an improper payment estimate for the Temporary Assistance for Needy Families program. EY also determined HHS did not achieve an improper payment rate of less than 10 percent for the Medicaid program; did not meet improper-payment-rate reduction targets for the Medicaid, Children's Health Insurance Program, and the Foster Care programs; and did not conduct recovery audits for the Medicare Advantage program.

18-A-17-105.01 to OS - Closed Unimplemented
Closed on 05/11/2018
We recommend that HHS continue to work with the OMB to develop and implement an approach to reporting on TANF improper payments in FY 2018.

18-A-17-105.02 to OS - Closed Unimplemented
Closed on 05/11/2018
We recommend that HHS and ACF continue working with states to (1) provide technical assistance and training related to policy updates and (2) support the Foster Care program in reaching its overall reduction goal target through appropriate implementation of corrective action plans at the state-level.

18-A-17-105.03 to OS - Closed Unimplemented
Closed on 05/11/2018
We recommend HHS proactively take action throughout the fiscal year to achieve its established improper payment reduction targets.Ā HHS continue to work with the Medicaid and CHIP plans and providers to communicate and monitor the adherence to such requirements throughout the year. HHS work with the states to bring their respective systems into compliance to fully implement NPI requirements.

18-A-17-105.04 to OS - Closed Implemented
Closed on 05/11/2018
We recommend that HHS focus on the root causes of the improper payment percentage and evaluate critical and feasible action steps to assist states with their compliance efforts for these new requirements. This would include working with the states to bring their respective systems into full compliance with the requirements to decrease the improper payment rate percentage below 10 percent. For states that are being measured a second time, HHS should work with the states to follow up on repeat root causes for errors and enhance the CAPs for implementation. In addition, as HHS only reviews 17 states each year for the Medicaid improper payment rate, HHS should continue to follow up with states during the interim period to verify that corrective actions identified after the improper payment error rate measurement review are being implemented.

18-A-17-105.05 to OS - Closed Unimplemented
Closed on 05/11/2018
We recommend that HHS actively explore a vehicle to conduct recovery audits that will fit into the larger Medicare Part C program in FY 2018. We also recommend HHS analyze the viability of issuing a contract that is cost-beneficial to the program.

18-A-17-105.06 to OS - Closed Unimplemented
Closed on 05/11/2018
Consistent with our FY 2015 performance audit, we recommend HHS correct the method for calculating the standard error to estimate the improper payments at the state level. In addition, HHS may need to increase the sample size at the state level to refine its calculation to meet OMB precision requirements at the national level.

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