OIG boosts HIX fraud watch

Vulnerabilities also discovered with CMS oversight of contractors
By Diana Manos
10:08 AM

The Office of the Inspector General has ramped up its oversight of the health insurance exchanges in the past six months.

In its newly released semiannual report to Congress, OIG says it focused on “core risk areas” associated with the marketplaces, including eligibility systems, payment accuracy, contractor oversight, and data security.

[See also: CMS called out for EHR fraud failings.]

“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.

Over the six months, which included the HIX open enrollment period, OIG officials said they worked with federal and state law enforcement to monitor the marketplaces for fraud.

OIG also found vulnerabilities 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.

HHS is also struggling with grants oversight and management, the report said, particularly the Child Care and Development Block Grant, which provides financial assistance for child care for approximately 1.6 million children each month.

[See also: A stark link between breaches and fraud.]