What GAO Discovered
The Indian Well being Service’s (IHS) third-party collections—that’s, funds for sufferers’ medical care acquired from public applications similar to Medicaid and Medicare or from personal insurers—elevated from about $943 million in fiscal yr 2015 to about $1.15 billion in fiscal yr 2019 at its federal services. In fiscal yr 2020—which included the start of the COVID-19 pandemic—collections decreased by about 4 p.c to $1.10 billion, however they rebounded to about $1.26 billion in fiscal yr 2021. In line with IHS, these collections are more and more vital, as they symbolize a good portion of services’ well being care supply budgets. In consequence, even a modest decline can have an effect on facility operations.
Whereas IHS headquarters conducts some oversight of third-party collections—together with reviewing services’ biannual information submissions—the company has delegated a lot of the accountability for this oversight to its space workplaces. Space workplace officers instructed GAO they oversee these funds by (1) taking steps to make sure services decide and confirm whether or not a affected person has or is eligible for insurance coverage from a third-party payer at every affected person go to, (2) usually speaking with and offering coaching to facility workers, and (3) usually reviewing facility data, together with services’ biannual information submissions earlier than they had been despatched to headquarters. IHS headquarters officers used these information submissions to establish any issues that have to be addressed by services in a corrective motion plan—similar to a backlog in billing. GAO’s overview of the 2 most up-to-date submissions confirmed all services throughout the 9 space workplaces submitted these information to headquarters.
When procuring services and products wanted for its operations, IHS could use the Purchase Indian Act to offer precedence to Indian-owned and -controlled companies with out utilizing a aggressive contracting course of. IHS’s use of the Act has elevated since fiscal yr 2015 however usually includes lower than 5 p.c of annual non-pharmaceutical contract obligations. (See determine.) IHS officers described actions they’ve taken that will have contributed to this improve, together with creating lists of identified Indian-owned companies to which IHS workers can refer when trying to find a services or products.
Indian Well being Service Non-Pharmaceutical Contract Obligations, Fiscal Years 2015–2020
Why GAO Did This Examine
IHS supplies care to American Indians and Alaska Natives (AI/AN) by way of a system of federally and tribally operated services. Along with receiving appropriated funds, IHS depends on funding from third-party collections to obtain companies, provides, and prescription drugs wanted for its operations. Making certain AI/ANs have entry to high quality well being care requires IHS to successfully handle its sources similar to third-party collections and procurement processes, together with these procurements made beneath the Purchase Indian Act.
GAO was requested to overview IHS’s oversight of third-party collections and its procurements. Amongst different issues, this report examines current tendencies in, and IHS’s processes to supervise, third-party collections and the extent to which IHS makes use of the Purchase Indian Act when procuring companies and merchandise, similar to medical provides. GAO reviewed company paperwork, together with insurance policies, and interviewed IHS officers from headquarters and the 9 space workplaces with two or extra federally operated services—space workplaces are liable for monitoring federally operated services’ operations and funds. GAO additionally reviewed information on third-party collections at IHS federally operated services for fiscal years 2015 by way of 2021 and analyzed contracting information from the Federal Procurement Knowledge System for fiscal years 2015 by way of 2020, the latest information obtainable on the time GAO started its overview.
For extra data, contact Michelle B. Rosenberg at (202) 512-7114 or RosenbergM@gao.gov.