Why the GAO Considers HHS a “High Risk”

The GAO cites deficiencies in the HHS program’s response to past PHEs.

Just last week, the Government Accountability Office (GAO) took a significant step by adding the U.S. Department of Health and Human Services (HHS) leadership and coordination of public health emergencies (PHEs) to its High Risk List.

The GAO is tasked with being a source of objective, non-partisan information on government operations, so it’s not surprising that they would turn their attention to the whopping $484 billion in COVID-19 relief funds that the HHS has received. Since the 1990s, the GAO has continually been on the lookout for areas of fraud, waste, and abuse, among other program vulnerabilities, and has been supported by the U.S. Senate Committee on Homeland Security and Government Affairs and by the U.S. House of Representatives Committee on Oversight and Reform. Since that time, they have logged hundreds of billions of dollars in financial benefits returned to the federal government from pursuing these areas deemed to be at high risk.

The GAO has been continually hinting at deficiencies in the HHS program’s response to past PHEs. For instance, in a March 2021 report, they stated, “in addition to specific areas that we have designated as high risk, other important challenges facing our nation merit continuing close attention. One of these is HHS’s leadership and coordination of public health emergencies.”

In HHS’s defense, coordinating a multi-agency response to a large-scale emergency is no easy task, even with substantial monetary support. In the end, it’s clear that attention to the matter is warranted, and the GAO knows that leaving deficiencies unaddressed will lessen the nation’s ability to respond to similar public health events in the future.

Now that the HHS is on the High Risk List, the GAO is specifically looking for the HHS to improve in the following areas:

1. Clearly defined roles and responsibilities;
2. Complete and consistent data;
3. Clear, consistent communication;
4. Transparency and accountability; and
5. Understanding of their key partners’ capabilities and limitations.

You might find yourself asking, how do you land such a designation, anyway? To determine which federal programs should be designated to be at high risk, the GAO uses its own guidance document considering qualitative risk factors, such as public health or safety, service delivery, national security, or whether the risk could result in significantly impaired services, program failure, injury, or loss of life. It’s also important to consider the risk of exposure from a quantitative perspective.

For instance, at a minimum, the monetary risk must be at the $1 billion mark; the COVID relief funds have certainly met that criterion. Other examples of quantitative vulnerabilities include assets being wasted, underutilized, or having some evidence of improper payments.

Let’s talk about getting off the List. There are five key elements that are carefully watched for as it pertains to progress to evaluate whether the criteria are met, partially met, or not met:

1. Leadership commitment;
2. Agency capacity;
3. Action plan;
4. Monitoring; and
5. Demonstrated progress.

HHS’s new spot on the list does ensure congressional and Executive Branch attention – and perhaps attention is what is required. The GAO will continually monitor HHS’s overall improvement and progress toward these criteria, and hopefully, in the end, this will a result in an improved national emergency response.

About the Author:

Leah is a health information management (HIM) compliance professional with more than 15 years of experience. Leah’s healthcare experience started in direct patient care, providing physical therapy, but now is focused on billing compliance for physician and non-physician practitioner services. Her goal is to protect patients by bringing clarity to complex healthcare regulations.

Contact the Author: leah.akers2008@gmail.com