HIX

May 30, 2014 by in Health IT, Research & Analytics

The Office of the Inspector General has beefed up its oversight of the health insurance exchanges in the past six months, according to its semiannual report to Congress.

As per the report, the OIG says it focused on “core risk areas” associated with the marketplaces, including eligibility systems, payment accuracy, contractor oversight and data security.

“We have completed significant aspects of data collection for some audits and evaluations, and resulting reports will offer recommendations to address vulnerabilities and better ensure marketplaces operate efficiently and effectively,” OIG officials wrote in the report.

In the past six months, which included the HIX open enrollment period, OIG officials said they worked with federal and state law enforcement to track healthcare marketplaces for fraud. OIG also found weaknesses in the Centers for Medicare & Medicaid Services oversight of the contractors that administer more than a half trillion dollars in benefits each year.

“Reports generated during this reporting cycle identified Medicare administrative contractor performance shortcomings and highlighted issues that limit CMS’s ability to effectively oversee Part C and Part D contractors,” the report said.

The Department of Health and Human Services is also struggling with grants oversight and management, according to the report, particularly the Child Care and Development Block Grant, which provides financial assistance for child care for approximately 1.6 million children each month.

Recently, the OIG stopped supporting a 2011 advisory opinion that favored a data exchange arrangement allowing EHR data to be shared for the purpose of patient referral.

At that time, it said, “Although the discount offered under the arrangement may not influence an ordering health professional to refer a patient to, for example, a trading partner specialist versus a non-trading partner specialist, it may influence an ordering health professional to choose a trading partner for services the ordering health professional orders with a high degree of frequency, because ordering those services from a non-trading partner effectively would require the ordering health professional to forfeit the amount of the discount.”

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