Department of Health and Human Services Met Many Requirements, but It Did Not Fully Comply With the Payment Integrity Information Act of 2019 and Applicable Improper Payment Guidance for the Fiscal Year 2023

Why OIG Did This Audit

The Office of Inspector General (OIG) must review the Department of Health and Human Services (HHS) compliance with the Payment Integrity Information Act of 2019 (PIIA, P.L. No. 116-117) and related applicable improper payment guidance. Ernst & Young (EY), LLP, under its contract with the HHS OIG, audited the fiscal year 2023 HHS improper payment information reported in the Agency Financial Report (AFR) to determine compliance with PIIA and related guidance from the Office of Management and Budget (OMB).

How OIG Did This Audit

Under its contract with OIG, EY assessed whether HHS complied with the PIIA reporting requirements and provided adequate disclosure within the annual AFR and accompanying materials.

What OIG Found

EY determined that HHS met many requirements but did not fully comply with PIIA. Among the items required for compliance with PIIA that HHS complied with, EY determined that HHS: (1) published the AFR for FY 2023, (2) conducted risk assessments for 56 programs not susceptible to improper payments and determined the programs were not at risk for improper payments, and (3) published corrective action plans for 10 of the 12 programs that are susceptible to significant improper payments as determined by HHS management, OMB or through legislation. EY also determined that HHS developed a plan to meet improper payment and unknown payment reduction targets for 4 of 12 programs; also reported an improper and unknown payment rate of less than 10 percent for 8 of the 12 programs.

EY concluded that HHS did not comply with several other PIIA requirements. EY found that HHS: (1) did not report an improper and unknown payment estimate for Temporary Assistance for Needy Families, and Foster Care; (2) reported a partial improper payment error rate for Advance Premium Tax Credit; (3) reported improper and unknown payment rates in excess of 10 percent for the Children’s Health Insurance Program; (4) HHS did not effectively demonstrate improvements to payment integrity for the Medicare Part C program; (5) HHS’s Sampling and Estimation Methodology Plan (S&EMP) did not completely measure all key characteristics of the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program; and (6) had recovery audit activities for the identified improper payments for the Medicare Advantage program, which were delayed or missing cost-effectiveness documentation.