Managers at the Health Care Financing Administration have too much to do and not enough money to do it with, the agency's new chief and the General Accounting Office said Thursday.
Given the raft of new missions resulting from recently enacted laws, "We are doing everything we can to get the job done with the resources we have," HCFA Administrator Nancy-Ann Min DeParle told the House Ways and Means Health Subcommittee Thursday, in her first formal congressional appearance since taking over the agency in November. But, DeParle continued, "The fact remains that our budgets have decreased in real terms, while our responsibilities have grown."
HCFA's 4,000 employees, who oversee the mammoth Medicare and Medicaid programs, must start up a new $20 billion children's health insurance program, rebuild an information technology strategy after a multi-billion contract for a new Medicare Transaction System failed, prepare its vast network of computer connections with states and contractors for the year 2000, and cut down the estimated $23 billion of improper payments Medicare makes each year. In addition, the 1997 Balanced Budget Act legislated 300 changes to the Medicare system on top of changes mandated by the 1996 Health Insurance Portability and Accountability Act.
"Substantial program growth and greater responsibilities appear to be outstripping HCFA's capacity to manage its increasing workload," testified William Scanlon, GAO's director of health financing and systems issues. "Senior and mid-level managers contend that HCFA is struggling to carry out Medicare's numerous and challenging activities."
HCFA's challenges are being magnified by a massive internal reorganization undertaken last summer, as well as an almost 40 percent staff turnover over the past five years. Highly experienced technical staff have retired or are eligible to retire soon, leaving managers concerned that they won't have the experienced staff needed to coordinate the varied initiatives for which the agency is responsible. Managers worry that regular responsibilities will fall by the wayside in a rush to comply with new congressionally mandated requirements.
"HCFA seems to be focusing most of its energy on important deadlines and pressures, but other critical functions may be receiving back burner attention," Scanlon said in his testimony.
Meanwhile, Medicare fraud investigators told the Senate Governmental Affairs Investigations Subcommittee Thursday that site checks of Medicare provider applicants could substantially weed out fraud. "I think we can make giant strides by not letting them into the system in the first place," said John Hartwig, Health and Human Services deputy inspector general of investigations.
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