The work plan specifies that "CMS relies extensively on contractors to help it carry out its basic mission, including administration, management, and oversight of its health programs…[but] Previous Government Accountability Office reports highlighted the vulnerabilities and weaknesses within the contracting environment at CMS.
Kusserow says that between the lines of the document, the issue revolves around the enormous amounts of money that the RACs deny on hospital claims, two-thirds of which are reversed when they get to the appeal level in front of the an administrative law judge.
Now, because of the backlog of claims on appeal, CMS has suspended assignment to ALJ hearings for at least 24 months, holding hospitals' claims funds in captivity. "The question is," he said, "what is the OIG doing about the problem? The appeals process is clogged, and what is (CMS) doing to streamline the process, so you don't have so many unmeritorious (RAC) contractor seizures" of hospital reimbursements?"
Questions About Contractors
Specific to the exchange rollout, 11 of the 60 new OIG projects involve the federal marketplaces—projects that were requested by HHS Secretary Kathleen Sebelius in a Dec. 10 letter to Inspector General Daniel Levinson.
She asked for reviews of the acquisition process for contracts to launch healthcare.gov, how contractors were selected, contract administration, "and the overall project management," and "whether contract specifications were met, and whether performance was adequately monitored.