GAO: Medicare, Medicaid and Veterans Health Administration at High Risk for Fraud, Waste, Abuse

The Government Accountability Office (GAO) has published its annual update of federal programs “that it identifies as high risk due to their greater vulnerabilities to fraud, waste, abuse, and mismanagement…”

Healthcare programs feature high on the list. Medicare, the entitlement program for seniors, and Medicaid, the joint state-federal welfare program for low-income households, are longstanding members of the list; and the GAO notes that legislation will be required to fix them:

We designated Medicare as a high-risk program in 1990 due to its size, complexity, and susceptibility to mismanagement and improper payments.

We designated Medicaid as a high-risk program in 2003 due to its size, growth, diversity of programs, and concerns about the adequacy of fiscal oversight.

So, that would be 25 years for Medicare and 12 years for Medicaid. Seen any progress? Unfortunately, the GAO recommends more top-down centralized control to fix the problems, instead of giving beneficiaries a financial interest in fixing the problems, as I proposed in a recent Washington Post column.

Remarkably, this is the first year that the Veterans Health Administration has made the list of high-risk programs. Much of the criticism is of the VHA’s misuse of new technology:

For example, we have reported on VA’s failed attempts to modernize its outpatient appointment scheduling system, which is about 30 years old. Among the problems cited by VA staff responsible for scheduling appointments are that the system requires them to use commands requiring many keystrokes and does not allow them to view multiple screens at once. Schedulers must open and close multiple screens to check a provider’s or a clinic’s full availability when scheduling a medical appointment, which is time-consuming and can lead to errors. VA undertook an initiative to replace its scheduling system in 2000 but terminated the project after spending $127 million over 9 years, due to weaknesses in project management and a lack of effective oversight. The department has since renewed its efforts to replace its appointment scheduling system, including launching a contest for commercial software developers to propose solutions, but VA has not yet purchased or implemented a new system.

I have previously discussed that the electronic health records (EHRs) at the VHA and the Department of Defense cannot speak to each other. The GAO report discusses this in depth:

Further, as we have reported for more than a decade, VA and the DOD lack electronic health records systems that permit the efficient electronic exchange of patient health information as military servicemembers transition from DOD to VA health care systems.

One location where the delays in integrating VA’s and DOD’s electronic health records systems have been particularly burdensome for clinicians is at the Captain James A. Lovell Federal Health Care Center (FHCC) in North Chicago, the first planned fully integrated federal health care center for use by both VA and DOD beneficiaries. We found in June 2012 that due to interoperability issues, the FHCC was employing five dedicated, full-time pharmacists and one pharmacy technician to conduct manual checks of patients’ VA and DOD health records to reconcile allergy information and identify possible interactions between drugs prescribed in VA and DOD systems.

Please note that the same federal government which, after over more than a decade, cannot effect interoperable health records between two of its own departments believes that it can do so for the entire country’s private doctors and hospitals.