Health and Human Services 2014-2018 Strategic Plan

The Department of Health and Human Services (HHS) recently released its draft strategic plan. The Strategic Plan is updated every four years and is designed to outline the key issues HHS is working to address. The 2014-2018 Strategic Plan was released in draft form on September 9, 2013 to allow for consultation with Congress and an opportunity for public comments, with the comment period running through October 15, 2013.

The Strategic Plan can offer healthcare providers insight into the current focus of HHS programs and activities. The plan outlines the agency’s goals and objectives for HHS over the next four years: (1) strengthen health care; (2) advance scientific knowledge and innovation; (3) advance the health, safety and well-being of the American people; and (4) ensure efficiency, transparency, accountability and effectiveness of HHS programs. Each of the stated goals has an impact on healthcare providers and the ways in which they deliver healthcare. Notably, Goal (4), which focuses on the efficiency and effectiveness of HHA programs, identifies a focus on strengthening program integrity in an ongoing effort to reduce improper payments, fight fraud and integrate risk management systems. These risk management efforts focus on stopping fraud, waste and abuse through the use of fraud detection technology, enhancements to provider screening and enrollment requirements, and an ability to stop fraudulent payments before they are made. These objectives align with HHS’s ongoing effort to move away from “pay and chase” model to a “prevent and detect” structure in the context of Medicare claim audits. The Strategic Plan identifies Medicare and Medicaid program integrity, as well as detection of Medicare fraud through the Department of Justice’s Health Care Fraud Prevention and Enforcement Action Team (HEAT). While these programs are not new, the discussion in the Strategic Plan suggests that providers can expect to see continued program integrity audits and initiatives in the future.

In recognition of the focus on program integrity, providers are encouraged to proactively engage in compliance efforts to ensure their practice is compliant with applicable coverage and billing guidelines. While it may not be possible to avoid an audit review, ensuring compliance with coverage policies can mitigate the impact of an audit on a practice.

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