Summary
In October 2002, we reported the results of our audit of selected internal control activities at three military treatment facilities: Eisenhower Army Medical Center, Augusta, Georgia; Naval Medical Center-Portsmouth, Portsmouth, Virginia; and Wilford Hall Air Force Medical Center, San Antonio, Texas. As part of our work for that report, we requested data files of all patients who had been admitted, treated as outpatients, or received pharmaceutical benefits during fiscal year 2001. Despite considerable effort by the three facilities, only Wilford Hall Air Force Medical Center was able to provide a file of beneficiaries who received pharmaceuticals during the year. We compared this file to data in the Social Security Administration's (SSA) Death Master File as a technique to identify instances of potential fraud or abuse. For Wilford Hall, we identified 41 cases in which a prescription was ordered for an individual after the date of his or her death as recorded in the SSA Death Master File. Congress requested that we determine whether individuals fraudulently obtained pharmaceuticals or other health benefits by assuming the identity of a dead person, and, if so, to identify the specific breakdowns in internal controls that allowed such fraud to occur. We confined our investigation to the 41 cases described above.
We did not find indications of individuals fraudulently obtaining health care benefits in our examination of the 41 cases we identified of people receiving treatment after they were listed in SSA's Death Master File. In 40 of the 41 cases, data entry errors and/or internal control weaknesses at either SSA or at the military treatment facilities created the impression that a deceased person had received prescriptions. Of the 40 cases, 10 were instances in which SSA's Death Master File had incorrectly listed as deceased the individual on whom a prescription was dispensed and 30 resulted from Department of Defense (DOD) data entry errors.
Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change
from "In process" to "Implemented" or "Not implemented" based on our follow up work.
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Recommendations for Executive Action
Recommendation: To strengthen controls over data entry into the DOD clinical records database and to help ensure that patient safety issues are identified, we recommend that the Secretary of Defense direct the Assistant Secretary of Defense for Health Affairs, in conjunction with the military services' Surgeons General, to institute a standardized preventive control procedure or procedures to prevent inadvertent entry of new clinical data into a deceased person's record clinical record in CHCS.
Agency Affected: Department of Defense
Status: Implemented
Comments: While DOD concurred with GAO's finding, it did not concur with the GAO recommendation. DOD's position was that the GAO report overstated the extent of the problem and that the small number of data entry errors compared to the number of prescriptions written annually does not warrant a global change to its processes for entering data into its clinical database. However, consistent with the intent of our recommendation, the agency has taken action to provide, as part of ongoing pharmacy training programs, a continuing emphasis on ensuring correct data entry. Consequently, the agency has taken appropriate and cost-effective action to achieve the intent of our recommendation--ensuring accurate clinical records data entry.
Recommendation: To strengthen controls over data entry into the DOD clinical records database and to help ensure that patient safety issues are identified, we recommend that the Secretary of Defense direct the Assistant Secretary of Defense for Health Affairs, in conjunction with the military services' Surgeons General, to institute a standardized preventive control procedure or procedures to prevent inadvertent entry of new clinical data into a deceased person's record clinical record in CHCSII.
Agency Affected: Department of Defense
Status: Implemented
Comments: While DOD concurred with GAO's finding, it did not concur with the GAO recommendation. DOD's position was that the GAO report overstated the extent of the problem and that the small number of data entry errors compared to the number of prescriptions written annually does not warrant a global change to its processes for entering data into its clinical database. However, consistent with the intent of our recommendation, agency has taken action to provide, as part of ongoing pharmacy training programs, a continuing emphasis on ensuring correct data entry. Consequently, the agency has taken appropriate and cost-effective action to achieve the intent of our recommendation--ensuring accurate clinical records data entry.
