The GAO Report Cited IHS Deficiencies, Column Brings them to Light

Lisa R. Shellenberger

Ms. Yvette Roubideaux, Director of Indian Health Service (“IHS”), recently submitted a column on ICTMN.com, titled “Correcting the Record on the Contract Health Services Program.”  This column was in response to the article I previously wrote, “Oversight by IHS Leaves Money on the Table, Patients Holding the Bag.”

The Indian Health Service has made marked improvements as an agency and in its programs while under the Roubideaux Administration.  This fact is not in dispute, and we applaud Ms. Roubideaux’s efforts and advances.  However, my purpose in writing the column on the Contract Health Services Program (“CHS”) was to highlight deficiencies that still linger despite the program’s progress as an attempt to create the awareness and attention needed to spur additional change.

Real deficiencies exist with regard to the accurate reporting on needed CHS Program funds – that is a reality that does not need correcting. The September 23, 2011 report titled, “Increased Oversight Needed to Ensure Accuracy of Data Used for Estimating Contract Health Service Needed” the U.S. Government Accountability Office (“GAO”) states, “Due to deficiencies in IHS's oversight of data collection, the unfunded services data on deferrals and denials that IHS used to estimate program need are incomplete and inconsistent. . . By not encouraging the reporting of unfunded services data from all [CHS] programs, IHS's data collection activities are not consistent with the Standard for Internal Control in the Federal Government. . .”

I brought to light these “deficiencies” by providing examples cited by the GAO.  I previously stated, “[I]n 2009, the federal government did not even receive information from 35 CHS programs.” Reliable data reporting is critical to receiving the maximum amount of funds possible from Congress for the CHS program.  If IHS under reports the need for CHS funds, then receiving adequate and sufficient funding to support the program is an impossibility.  Moreover, inconsistent and incomplete data could create congressional skepticism regarding the report on needed funds for CHS.

I have no doubt that the efforts of the IHS and tribal workgroup to develop a new, reliable method of obtaining data on unfunded services has been valuable and have been done in good faith.  However, the issue is the delay in the implementation of a new method.  Again, according to the report, “[A]s of September 2011, IHS officials told us that the agency had not determined whether it would make improvements to the collection of deferral and denial data . . .”

Finally, Ms. Roubideaux stated that the IHS is grateful for the recommendations from the GAO study, as the recommendations will help IHS's ongoing efforts to improve the CHS program.  I, too, am grateful for this study, as I am sure many tribes and tribal members are as well.  It is important that the agency charged with providing health care to 1.9 million American Indians and Alaska Natives is closely scrutinized to ensure that it is providing the best health care possible.  As a result, ongoing efforts to improve the CHS program can only benefit from increased awareness and an informed public.

Lisa R. Shellenberger is an Associate Attorney at the law firm of Smith, Shelton & Ragona, in Westminster, Colorado.

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member's picture
Thank you!
porkthunder's picture
IHS can not mandate reporting from Self-Governance Tribes. They have no choice but to under-estimate the CHS need, since Tribes frequently choose not to report, for various reasons. The GAO doesn't understand Tribal Self-Governance, nor does anyone else who agrees with their persistent prescriptions for more federal oversight.
duwaynesmith's picture
You have to read GAO reports with a word of caution. As a retired federal employee, I have observed the methods used by GAO teams in their investigative efforts, and have heard others talk about their experiences. The GAO frequently comes into the process with "a priori" ideas about what is wrong and collects information to support their presuppositions. The GAO proceeds, sometimes, with a political agenda. It is not a totally objective process. The GAO team frequently knows little about the operations of the agency they are investigating, and go from one unrelated agency to another at a fairly rapid pace.
moosebeard's picture
Is it any wonder I am stuck with a hefty bill for ambulatory services in Phoenix AZ that the so called IHS Navajo service unit refuses to consider. IHS relays to me contract care requires prior approval irregardless if you are involved in a accident. So much for leaving the rez to seek a better life.