The Department of Health and Human Services Office of the Inspector General intends to focus its investigations in fiscal year 2015 on the public health care exchanges, adding 5-10 reviews over the course of the year.
In its Health Reform Oversight Plan for Fiscal Year 2015, the Office of the Inspector General lays out its plans for the year ahead which states where it will focus its allocated resources. While the report mentions multiple areas the IG will work on, including Medicaid, the majority of the outline focuses on the health insurance exchanges.
Specific areas the OIG intends to examine related to the marketplace are:
- Payment: Are taxpayer funds being expended correctly?
- Eligibility: Are the right people getting the right benefits?
- Management and Administration: Is HHS managing and administrating federally-facilitated marketplace programs effectively and efficiently?
- Security: Is consumers personal information safe?
The outline states the office will add up to 10 reviews in 2015. Multiple requests for comment were not returned.
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Katherine Hempstead, a director at the non-partisan Robert Wood Johnson Foundation, would like to know how much of the budget is going to ACA compliance as HHS continues to make that a priority. It is interesting premium stabilization came up twice [in the report]. [The OIG] seems to be hitting on some of the hot-button issues, she says. It doesnt surprise me. It seems like they are looking at things other people have put under the microscope.
Even so, Alden Bianchi, member of law group Mintz Levin in Boston, would not read anything into this report other than, OIG is interested in making sure that the ACA marketplaces are functioning as intended.
The tenor and tone of the document, however, says Bianchi, practice group leader of the Mintz Levins employee benefits and executive compensation practice, show that the target of the office this fiscal year will be the public marketplaces. Thus, employers, for example, do not appear to have much to worry about, he adds.
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Hempstead says the investigations are a good thing assuming their methods are good and people feel their conclusions are sound. She explains that a prospective plan by OIG to look at the relationship between payment reform and quality outcomes caught her eye and struck me as requiring a more complicated research design and a longer time frame than what they might ordinarily use in their work.
But what actually becomes of the audit is the real question, Bianchi says. Marketplaces are quasi-public entities that serve as conduits for private sector products issued by state-licensed insurance carriers that are already highly regulated at the state level, he says. If the OIG process is anything like the state-level market conduct examinations, then there will be little for the marketplaces and carriers to worry about.
