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GAO: IHS muddles revenue collections

WASHINGTON – A new report by the U.S. Government Accountability Office confirms some costly concerns regarding the collection of third-party payments owed to the IHS by insurers. Some tribal affairs experts say IHS’ laxity has ended up shortchanging tribal governments and the health of tribal citizens.

One of the report’s most serious findings is that the agency’s procedures for collecting monies from private insurers are muddled.

IHS largely follows federal standards, the report found, but the agency’s overall collection monitoring is inadequate, some financial systems have not been updated, and agency offices are operating under different debt collection plans.

The report found that the problems have likely correlated with IHS not maximizing its collection of money owed by third-party insurers, which it is supposed to do under law.

The Indian Health Care Improvement Act authorizes the agency to collect reimbursement for services provided at IHS facilities from third-party insurers, including Medicare, Medicaid and private companies.

How much money has been left off the table?

In May 2008, Sen. Jon Tester, D-Mont., wrote a letter to then-IHS Director Robert McSwain regarding the problem, which has long been raised by tribal advocates because they have feared that health care for tribal citizens has been compromised.

McSwain estimated IHS collected about 60 percent of what it was owed in fiscal year 2007, which he equated to about $90 million that year.

From that number, it can be reasoned that IHS failed to collect a total of $60 million in 2007 alone.

While the GAO report doesn’t get into deducing those kinds of specific numbers, some tribal affairs experts have already done so, including Tom Rodgers, a Blackfeet citizen and lobbyist with Carlyle Consulting.

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“There is an incredible need to be able to assess and quantify the number of dollars at stake,” Rodgers said.

“Tribal governments need to understand the scope of the situation, so they can fight to get these critical dollars returned to them and really improve the health of their people.”

Rodgers has long paid attention to what he believes have been lax IHS collection procedures because he’s been worried that tribal citizens have been shafted due to lack of IHS funding – a well-known and perennial problem. He has also helped the Senate and GAO investigators in their efforts to understand the extent of the situation.

Sen. Max Baucus, D-Mont., chairman of the U.S. Senate Finance Committee, is one legislator who has been especially concerned.

“Right now, American Indians and Alaska Natives are suffering because IHS lacks adequate resources to provide the quality care they need. …” he said upon release of the GAO report, which he requested in early 2008.

“These lapses are unacceptable. I will be tracking the improvement effort carefully and will demand a follow-up report by GAO.”

Baucus also said that current IHS Director Yvette Roubideaux has told him that changes are being made to improve IHS’ collection of payments.

Along those lines, the GAO made several recommendations, including calling for IHS to develop tools for managing and monitoring its payment collection and debt management.

The IHS press office would not offer specific comment on the report, but did note that agency officials have reviewed and agreed with it.

The report noted that agency officials contributed to it and said IHS has already taken steps to ensure the accuracy of its reports and debt management procedures by increasing its oversight capabilities, implementing a new Web-based monitoring service and giving direct line authority to a new position entitled the Deputy Director of Field Operations.