Summary

Pursuant to a congressional request, GAO provided information on the decline in the Department of Health and Human Services (HHS) Inspector General's (IG) investigative resources and on other federal and state actions designed to improve health care fraud investigative and enforcement activities.

GAO noted that: (1) during February 1993, the IG began implementing a strategic plan developed by its Office of Investigations to address budget limitations and investigative staff reductions and to help it continue to fulfill its investigative responsibilities; (2) the plan focused investigative resources on states that received the most HHS money; (3) as of February 1997, the IG's Office of Investigations had 237 staff located in 27 states, the District of Columbia, and its headquarters office; (4) in the past few years, several actions have been taken to improve health care fraud investigative and enforcement activities across the country; (5) Operation Restore Trust, which began in 1995 as a 2-year demonstration program and was extended in 1997, is a collaborative federal and state effort to fight fraud, waste, and abuse in selected health care areas; (6) the Health Insurance Portability and Accountability Act (HIPAA) of 1996 calls for the HHS Secretary, acting through the HHS IG, and the Attorney General to establish a health care fraud and abuse control program; (7) this program is intended to, among other things, coordinate federal, state, and local law enforcement programs to control fraud and abuse in health plans, and to conduct investigations and other actions relating to the delivery of and payment for health care; (8) using its $27-million budget increase over fiscal year (FY) 1996, the IG plans, in part, to increase investigative staff by approximately 60 in FY 1997; (9) the budget increase resulted from $70 million provided by HIPAA for health care-related fraud and abuse efforts and a $43 million decrease in the IG's discretionary budget; (10) if the IG receives the maximum amount of funding permitted under HIPAA after FY 1997, the IG plans to have investigators in almost all states by the year 2002; and (11) other federal and state organizations, such as the Federal Bureau of Investigation and State Medicaid Fraud Control Units, participate in efforts to reduce health care fraud, and the Health Care Financing Administration has begun an effort to improve the Medicare claims processing system.