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 2022

05-19-2023 | A-17-23-52000 | Complete Report

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 2022 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

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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 2022, (2) conducted risk assessments for 43 programs not susceptible to improper payments and determined the programs were not at risk for improper payments, and (3) published corrective action plans for 9 of the 13 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 6 of 13 programs; also reported an improper and unknown payment rate of less than 10 percent for 7 of the 13 programs.

EY concluded that HHS did not comply with several other PIIA requirements. EY found HHS (1) HHS did not conduct improper payment risk assessments for each program with annual outlays greater than $10 million at least once every three years; (2) did not report an improper and unknown payment estimate for Covid-19 UIP, Temporary Assistance for Needy Families, Foster Care, and Head Start programs; (3) reported improper and unknown payment rates in excess of 10 percent for Medicaid, and Children's Health Insurance Program; (4) had completed minimal recovery audit activities for the identified improper payments for the Medicare Advantage and Medicare Prescription Drug Benefit programs; (5) did not effectively demonstrate improvements to payment integrity for the Medicare Fee For Service program; and (6) has not calculated and reported an improper payment estimate for the state-based exchanges of the Advance Premium Tax Credit program.

Filed under: General Departmental