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HHS OIG — Ensuring the Integrity of Medicare Part D

July 16, 2015 Comments off

Ensuring the Integrity of Medicare Part D
Source: U.S. Department of Health and Human Services, Office of Inspector General

In the 9 years since Part D began, OIG has produced a wide range of investigations, audits, evaluations, and legal guidance related to Part D program integrity. This work has resulted in the prosecution of individuals accused of defrauding Part D, as well as the identification of systemic program vulnerabilities that raise concerns related to both inappropriate payments and quality of care. OIG has made recommendations to strengthen Part D program integrity, and progress has been made. However, Part D remains vulnerable to fraud, as evidenced by ongoing investigations. OIG has prepared this portfolio to document key progress in addressing Part D program vulnerabilities and to highlight issues that need improvement.

See also: Questionable Billing and Geographic Hotspots Point to Potential Fraud and Abuse in Medicare Part D

Pentagon acquisition policy: Three-quarters right, one-quarter broken

July 14, 2015 Comments off

Pentagon acquisition policy: Three-quarters right, one-quarter broken
Source: Brookings Institution

The American defense debate is afflicted by a certain schizophrenia about how the Pentagon buys its weapons and other equipment, and about the state of America’s defense industrial base. On the one hand, the media narrative often fixates on horror stories concerning $600 toilet seats, billion-dollar aircraft and ships, fighter jets costing three times what was originally expected, and programs canceled for poor performance. The Department of Defense went into the Iraq and Afghanistan wars only moderately well prepared, in terms of equipment and training, for the kind of fighting that ensued, and took several years to find its stride. Eisenhower’s warnings of a military-industrial complex bilking the taxpayer and putting the nation’s economy at risk still echo today—but now it is the military-industrial-congressional complex that adds parochial politics and log-rolling appropriators to the witches’ brew as well.

Following the Money 2015: How the 50 States Rate in Providing Online Access to Government Spending Data

July 10, 2015 Comments off

Following the Money 2015: How the 50 States Rate in Providing Online Access to Government Spending Data
Source: U.S. PIRG

Every year, state governments spend hundreds of billions of dollars through contracts for goods and services, subsidies to encourage economic development, and other expenditures. Accountability and public scrutiny are necessary to ensure that the public can trust that state funds are spent as well as possible.

In recent years, state governments across the country have created transparency websites that provide checkbook-level information on government spending – meaning that users can view the payments made to individual companies as well as details about the goods or services purchased or other public benefits obtained. These websites allow residents and watchdog groups to ensure that taxpayers can see how public dollars are spent.

In 2015, all 50 states operated websites to make information on state expenditures accessible to the public and these web portals continue to improve. For instance, in 2015, all but two states allow users to search the online checkbook by agency, keyword and/or vendor, and 44 states provide checkbook-level data for one or more economic development subsidy programs. Many states are also disclosing new information and are making it easier for outside researchers to download and analyze large datasets about government spending.

This report, our sixth annual evaluation of state transparency websites, finds that states continue to make progress toward comprehensive, one-stop, one-click transparency and accountability for state government spending. Over the past year, many states have launched new and improved websites to better open the books on public spending, or have adopted new practices to further expand citizens’ access to critical spending information. Some states, however, still have a long way to go.

Systematic Bias and Nontransparency in US Social Security Administration Forecasts

July 7, 2015 Comments off

Systematic Bias and Nontransparency in US Social Security Administration Forecasts (PDF)
Source: Journal of Economic Perspectives

In the conclusion of the article, we argue that the Social Security Administration and its Office of the Chief Actuary should follow best practices in academia and many other parts of government and make their forecasting procedures public and replicable, and should calculate and report calibrated uncertainty intervals for all forecasts. In a companion paper, we offer an explanation for the origin of the biases reported here and propose simple structural ways of changing the system to fix the problems going forward.

Health care fraud and abuse enforcement: Relationship scrutiny

July 5, 2015 Comments off

Health care fraud and abuse enforcement: Relationship scrutiny
Source: Deloitte

Where is fraud and abuse enforcement headed in health care? One emerging area of interest is relationship scrutiny. Relationships can be complex in the business of health care: tracking and analyzing them is an important part of minimizing the fraud and abuse that may result from questionable relationships and improper influence.

Many organizations depend on analytics to understand their own performance. Insights and patterns within the data are often used to inform strategy and decision making. Researchers can apply analytics to identify external trends and factors that may impact businesses. To that end, Deloitte researchers used analytics techniques to examine the text of tens of thousands of federal regulations and identify emerging trends in health care fraud and abuse enforcement. The results are telling: Federal health care regulators are emphasizing relationship scrutiny in their fraud and abuse enforcement efforts. Also, discussion of health care fraud and abuse topics – including relationship scrutiny – is recurring, as evidenced by the cyclical rise and fall in frequency and relevance of keyword groups related to “enforcement,” “value-based care,” and “fraud and abuse.” The bottom line: discussion of these topics is present; relationship scrutiny is likely here to stay.

Minimizing the risk of health care fraud and abuse doesn’t have to be an impossible task. New insights can come from the application of analytics to an organization’s data sets. These insights, in turn, can be used to build a fraud and abuse risk-mitigation program.

This paper examines health care fraud and abuse enforcement drivers and laws, the cyclical trend of relationship scrutiny within the regulatory discussion, and how health care organizations can build a responsive, analytics-based program to address potential fraud and abuse. An effective program will likely enable organizations to identify risks in real time, adjust to mitigate them, communicate their importance, and learn from the regulatory and legislative landscape.

Donor Governance and Financial Management in Prominent U.S. Art Museums

June 29, 2015 Comments off

Donor Governance and Financial Management in Prominent U.S. Art Museums
Source: Social Science Research Service

I study “donor governance,” which occurs when contributors to non-profit firms place restrictions on their gifts to limit the discretion of managers. In a study of U.S. art museums, I find that this practice has grown significantly in recent years, and it represents the largest source of permanent capital in the industry. When donor restrictions are strong, museums shift their cost structures away from administration and toward program services, and they exhibit very high savings rates, retaining in their endowments 45 cents of each incremental dollar donated. Retention rates are near zero for cash generated from other activities. Restricted donations appear to stabilize non-profits and significantly influence their activities, but they reduce management flexibility and may contribute to lower profit margins. Rising donor governance in U.S. art museums may represent a reaction by contributors to the industry’s high rates of financial distress, weak boards of trustees, and large private benefits of control enjoyed by managers.

U.S. Financial Services Credit Ratings Are Resilient To Cyber Security–For Now

June 17, 2015 Comments off

U.S. Financial Services Credit Ratings Are Resilient To Cyber Security–For Now
Source: Standard & Poor’s

It seems not a week goes by without a high-profile cyber-attack against a major U.S. corporation or government agency. A sampling of past corporate targets includes giant retailers (Home Depot, Target, Sony), banks (JPMorgan Chase, Citibank), and health insurers (Anthem, Premera Blue Cross). Clearly, no entity is safe from a cyber-attack. But what are the credit implications of this onslaught of data breaches? Although the many successful cyber-attacks have not yet resulted in any changes in Standard & Poor’s Ratings Services’ ratings on financial services companies, we view cyber-security as an emerging risk that we believe has the potential to pose a higher credit risk to financial services firms in the future, although we cannot predict the timing. It’s not difficult to envision scenarios in which criminal or state-sponsored cyber-attacks (for credit implications, we don’t differentiate the sources of intrusion) would result in significant economic effects, business interruption, theft, or reputational risk. One key point is that cyber-attacks may not be discovered immediately: It can take weeks or months before an intrusion is discovered.

Cyber-attacks appear random but could be highly correlated thanks to contagion caused by global interconnectivity. Data interconnectivity exists among banks, merchants, data owners (health care providers, telecom companies, etc.), and other sources (vendors, distributors, suppliers). So, hackers have many paths to breaching company data and disrupting business operations. Published reports note that data breaches have been going on long enough for cyber-criminals to have collected substantial data on a large number of individuals.

Overview

  • So far, we have not downgraded any companies because of the damage resulting from a cyber-attack.
  • Although company disclosures about cyber-risks remain limited, we’re starting to explore the issue in the context of management governance and enterprise risk management.
  • Although still too small to draw robust statistical conclusions, our analysis provides insights into how and when cyber-attacks can affect creditworthiness.
  • Our credit opinion takes into account a balanced view including other risk factors concerning the effects of a cyber-attack.
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