U.S. Department of Health and Human Services Met Many Requirements, but It Did Not Fully Comply With the Payment Integrity Information Act of 2019 and Applicable Improper Payment Guidance for Fiscal Year 2020

Why OIG Did This Audit

The Office of Inspector General (OIG) must review the Department of Health and Human Services' (HHS's) compliance with the Payment Integrity Information Act of 2019 (PIIA, P.L. No. 116-117) and related applicable improper payment guidance. Ernst & Young (EY), LLP, under its contract with the HHS OIG, audited the fiscal year (FY) 2020 HHS improper payment information reported in the Agency Financial Report (AFR) to determine compliance with PIIA and related guidance from the Office of Management and Budget (OMB).

How OIG Did This Audit

Under its contract with OIG, EY assessed whether HHS complied with the PIIA reporting requirements and provided adequate disclosure within the annual AFR and accompanying materials

What OIG Found

EY determined that HHS met many requirements but did not fully comply with PIIA. Among the items required for compliance with PIIA that HHS complied with, EY determined that HHS: (1) published the AFR for FY 2020, (2) conducted risk assessments for 23 programs not susceptible to improper payments and determined the programs were not at risk for improper payments, and (3) published corrective action plans for 9 of the 13 programs identified as susceptible to significant improper payments or deemed by OMB to be susceptible to significant improper payments. EY also determined that HHS published and met annual reduction targets for the 2 programs for which it reported reduction targets in the FY 2019 AFR and reported an improper payment rate of less than 10 percent for 7 of the 13 programs identified as or deemed to be susceptible to significant improper payments.

EY concluded that HHS did not comply with several other PIIA requirements. EY found that HHS: (1) did not report an improper payment estimate for the Temporary Assistance for Needy Families program, (2) reported improper payment rates in excess of 10 percent for Medicaid and the Children's Health Insurance Program, and (3) did not conduct recovery audits for the Medicare Advantage program. In addition, EY found that HHS did not record an improper payment estimate for the following programs: Advanced Premium Tax Credit, and the Centers for Disease Control and Prevention and Office of Head Start disaster relief programs.