Expanding primary care, tackling fraud are in plans for federal agencies

Carole Johnson, administrator of the Health Resources and Services Administration in the U.S. Department of Health and Human Services, speaks during the hearing “Examining Existing Federal Programs to Build a Stronger Health Workforce and Improve Primary Care," held April 19, 2023, by the Health Subcommittee of the Energy & Commerce Committee of the U.S. House of Representatives. This screen shot was taken from the live webcast of the hearing.

Primary care and health care fraud were on the agenda in hearings this week for the Energy & Commerce Committee of the U.S. House of Representatives.

On April 19, the Health Subcommittee held the hearing “Examining Existing Federal Programs to Build a Stronger Health Workforce and Improve Primary Care.” The members discussed those issues with Carole Johnson, administrator of the Health Resources and Services Administration (HRSA) in the U.S. Department of Health and Human Services (HHS).

Johnson spoke about the Health Center Program, the National Health Service Corps, and the Teaching Health Center Graduate Medical Education Program, three programs dealing with primary care. Their funding expires at the end of this fiscal year, although President Joe Biden’s fiscal year 2024 budget includes money for them.

“This investment would maintain and expand access to primary care services in underserved and rural communities, build and sustain the workforce needed to deliver this care, and expand the availability of mental health and substance use services and professionals across the country,” Johnson said in her written testimony.

HRSA supports almost 1,400 community health centers that provide primary care in rural and underserved communities. More than 20,000 physicians and clinicians in those areas earn scholarships and loan repayment assistance for their work, Johnson said. HRSA-supported community health centers provide primary care to 30 million people and that could grow to as many as one in 10 people across the nation.

Johnson spoke about increasing access to care through community health centers and integrating mental health; substance use disorder in primary care; and developing the nation’s health care workforce.

The subcommittee agenda included a number of bills for discussion. Questions and testimony lasted at least 2 ½ hours, with questions from at least 22 representatives, including some who are physicians and pharmacists.

Along with the HRSA and other HHS programs, one way to help is to pay more to primary care physicians.

“I want to start out by saying one of the ways we can get more physicians in underserved areas is properly reimburse primary care doctors for their services, instead of continuing to cut reimbursement in a failed attempt to control health care costs, which physicians are only about 10, 15 percent of the health care dollar,” said Rep. Larry Bucschon, MD (R-Indiana). “And in the long run this would actually save us money because it would make our population much more healthy.”

Inspector general testifies

On April 18, the Subcommittee on Oversight and Investigations Subcommittee held the hearing “Insights from the HHS Inspector General on Oversight of Unaccompanied Minors, Grant Management, and CMS.” The members heard testimony from HHS Inspector General Christi A. Grimm.

HHS-OIG has a current budget of $432.5 million – no small sum, but just two cents to oversee every $100 in spending by HHS. It is the largest civilian agency in the federal government, with an annual budget of $1.7 trillion, and it is the largest grantmaking and second-largest contracting agency in the federal government, with grants and contracts totaling $236.5 billion.

“Accordingly, the department’s size, budgetary resources, and diverse programs make it susceptible to fraud, waste, and abuse,” the subcommittee’s hearing memo said, and Grimm agreed.

As the COVID-19 pandemic public health emergency winds down, states are redetermining Medicaid eligibility for people, a potential area for errors and fraud, Grimm said.

According to research estimates, 3 percent to 10 percent of total health care spending – or about $129 billion to $430 billion – is lost to fraud each year, Grimm said. Current technology has allowed once-local fraudsters to spread schemes across the country, she added.

In fiscal year 2022, HHS-OIG netted about $2.7 billion in investigative recoveries with 1,446 criminal and civil actions, with 2,332 “untrustworthy individuals and entities” excluded from participating in federal health care programs, Grimm said in her written testimony.

HHS-OIG has been turning down 300 to 400 viable criminal and civil health care fraud cases a year due to staff shortages, Grimm said.

“I do not want to give the impression that we are not addressing serious fraud and abuse,” Grimm said. “We are, and our statistics and return on investment show it. However, with current resources we cannot keep up with the level of threat to HHS, patients, and taxpayer dollars. Every day we make tough choices on cases and issues to decline.”

Much of the subcommittee meeting dealt with HHS oversight of Unaccompanied Children Program run by the Administration for Children and Families’ Office of Refugee Resettlement within HHS. The program cares for children who have no lawful immigration status in the United States and do not have a parent or legal guardian available to provide care and physical custody.