Ex­changes on HHS in­spec­tor gen­eral’s agenda

Modern Healthcare - - Q&A -

Daniel Levin­son heads HHS’ Of­fice of the In­spec­tor Gen­eral and is chief watch­dog for fraud and abuse in Medi­care and Med­i­caid, over­see­ing 1,500 em­ploy­ees. An at­tor­ney, Levin­son pre­vi­ously served as deputy gen­eral coun­sel for the U.S. Of­fice of Per­son­nel Man­age­ment, gen­eral coun­sel for the U.S. Con­sumer Prod­uct Safety Com­mis­sion, chair­man of the U.S. Merit Sys­tems Pro­tec­tion Board, and in­spec­tor gen­eral for the U.S. Gen­eral Ser­vices Ad­min­is­tra­tion. Mod­ern Health­care re­porter Joe Carl­son re­cently spoke with Levin­son about the agency’s pri­or­i­ties in in­ves­ti­gat­ing the use of elec­tronic health records, billing in Medi­care’s pre­scrip­tion drug pro­gram and his of­fice’s chang­ing budget for staffing. This is an edited ex­cerpt.

Mod­ern Health­care: Why are in­ves­ti­ga­tors so in­ter­ested in po­ten­tial fraud and abuse re­lated to what physi­cians are do­ing on their per­sonal elec­tronic health-record screens as far as cut­ting and past­ing text from a tem­plate or from some­one else’s med­i­cal record and putting it into a new record?

Daniel Levin­son: That’s all part of our at­tempts to en­sure there is ap­pro­pri­ate ac­cu­racy with re­spect to billing. There is cer­tainly the po­ten­tial for abuse in cut­ting and past­ing. There are also some real ef­fi­cien­cies that can oc­cur as well. So we’re tak­ing a very so­phis­ti­cated ap­proach to­ward un­der­stand­ing where the pos­si­ble vul­ner­a­bil­i­ties are in that kind of prac­tice.

MH: Is your of­fice watch­ing how the federal in­cen­tive pay­ments to providers to in­stall EHR sys­tems are be­ing spent?

Levin­son: It’s high on our list.

MH: What about watch­ing the Medi­care Part D drug ben­e­fit pro­gram in terms of pre­vent­ing waste, fraud and abuse.

Levin­son: Part D continues to be an in­creas­ingly sig­nif­i­cant part of the menu of is­sues that we deal with, and we are go­ing to be look­ing at all as­pects of the trans­ac­tional work that oc­curs in Part D.

MH: There have been a se­ries of au­dits into hos­pi­tals look­ing at a num­ber of stan­dard mea­sures and ar­eas where many hos­pi­tals trip up in their billing. What is the sta­tus of that ef­fort?

Levin­son: That’s an on­go­ing process.

MH: Are budget changes af­fect­ing your of­fice’s staffing and work­load?

Levin­son: Some of the sup­ple­men­tal fund­ing that we had re­ceived early on with the Af­ford­able Care Act no longer ex­ists, and as a re­sult we’ve not been able to re­place people who have re­tired, so our work­force is not quite as large as it was a cou­ple of years ago. That said, be­cause of the re­cent budget pas­sage, we have been able to sta­bi­lize our fund­ing. We re­ceived a sig­nif­i­cant in­crease in our so-called dis­cre­tionary fund­ing, a lot of which will go to bol­ster­ing our over­sight of the Af­ford­able Care Act. But over­all we re­tain a very ex­pe­ri­enced and solid work­force.

MH: What are the Af­ford­able Care Act ar­eas of ac­tiv­ity that are go­ing to be in­creas­ing?

Levin­son: We are fo­cus­ing es­pe­cially on the in­sur­ance mar­ket­places to en­sure pay­ment ac­cu­racy, look at el­i­gi­bil­ity and ex­am­ine the con­tracts since the con­trac­tors have played an im­por­tant part in build­ing, and hope­fully fix­ing and main­tain­ing the sys­tem that un­der­pins the mar­ket­places. We’ll be look­ing at con­tract plan­ning, ac­qui­si­tion, con­tract man­age­ment and per­for­mance.

MH: What about Medi­care fraud and abuse?

Levin­son: We’re con­tin­u­ing to de­vote as many re­sources as we can to our anti-fraud ef­forts in the cities that we’ve had sig­nif­i­cant task force suc­cesses in places like South Florida, Hous­ton and Los Angeles. We’re do­ing im­por­tant work with the CMS in look­ing at some of the demon­stra­tion and pi­lot pro­grams on im­prov­ing qual­ity and ef­fi­ciency, try­ing to un­der­stand how these new de­signs can be most ef­fec­tive within the con­text of our anti-fraud laws.

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