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Department of Health &Human Services Program Integrity Initiative Molly Dawson Director, HHS Financial Policy &

Department of Health &Human Services Program Integrity Initiative Molly Dawson Director, HHS Financial Policy & Reporting. Overview. Background of Program Integrity at HHS What is Program Integrity? Purpose of Program Integrity Relationship of Program Integrity and FMFIA

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Department of Health &Human Services Program Integrity Initiative Molly Dawson Director, HHS Financial Policy &

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  1. Department of Health &Human Services Program Integrity InitiativeMolly DawsonDirector,HHS Financial Policy & Reporting

  2. Overview • Background of Program Integrity at HHS • What is Program Integrity? • Purpose of Program Integrity • Relationship of Program Integrity and FMFIA • How Does Program Integrity Work? • How Can You Bring Program Integrity to Your Organization?

  3. Background on the HHS Program Integrity Initiative • May 13, 2010 Secretary Sebelius announced the HHS Program Integrity Initiative • Congress allocates more money in the federal budget for HHS than any other Department • More than $900 Billion dollars in public investments each year • Given the Department’s mission to protect all Americans’ health and provide essential human services, HHS leadership is committed to ensuring program dollars are not lost due to fraud, theft, mismanagement, etc.

  4. What is Program Integrity? • HHS and External Entities working together • Effectively, Efficiently, and Ethically • In line with the HHS mission Bottom Line: Make HHS money go further! PROGRAM INTEGRITY

  5. What is Program Integrity? • HHS Official Definition • “The operation of HHS’ programs, by both HHS and our external partners, in an effective, efficient, and ethical manner and without conflict of interest or the appearance of conflict of interest, in accordance with applicable laws and regulations. In line with HHS program mission, goals, and objectives, the intended recipients are provided the proper payments, services and benefits while ensuring quality, safety, and access.”

  6. Purpose of Program Integrity? • Meet taxpayers’ expectations that tax dollars are spent properly; • Make sure the correct population is served; • Ensure that recipients can and are managing federal funding in an effective and prudent manner, including the federal dollars managed by sub-recipients; • Ensure maximum impact of federal dollars; and • Minimize risk of program failure or bad publicity.

  7. Program Integrity Program Operations & Business Functions Operating Divisions Staff Divisions Regional Offices Grantees Contractors Taxpayers People Served

  8. Program Integrity vs Ethics • Not legally mandated • Focus on program, not individuals • Improve effectiveness and efficiency • Does not govern behavior

  9. Program Integrity & FMFIA • FMFIA, When Done Properly Supports Program Integrity • Program Integrity is a Subset of the Annual FMFIA Assessment • Program Integrity Evaluates Internal, External, and Inherent Risk • Program Integrity Requires Participation of External Partners to be Successful

  10. How is HHS Enhancing Program Integrity? • Established the Secretary’s Council on Program Integrity • Comprised of Division Heads • Each Division Head is Directly Accountable • Established Sub-group – Program Integrity Coordinating Council (PICC) • Comprised of a Direct Report Representative from each Division • Responsible for Implementing the Initiative in the Division • PICC Meets Monthly • Address Program Integrity Issues • Share best practices

  11. Office of Program Integrity Coordination (OPIC) • OPIC was formed to coordinate the Department’s program integrity efforts • OPIC also has responsibility for implementing the Improper Payments Information Act and associated directives

  12. HHS Program Integrity InitiativeWhat is It?

  13. The Program Integrity Lifecycle Each Program Integrity Review follows the 4 stages of the Program Integrity Lifecycle (shown to left). Stage 1 – Identify Risks Stage 2 – Develop Risk Response Strategy and Corresponding Metrics Stage 3 – Implement Response Strategy Stage 4 - Measure and Test Efficacy of Response strategy; Modify as Necessary STAGE 4 Monitor Risks STAGE 1 Identify Risks STAGE 3 Implement Risk Response Strategy STAGE 2 Develop Risk Response Strategy Each program will follow the same general review cycle.

  14. Risk Assessment Process: AStep-by-Step Overview *Minimum time expectations for program involvement. The exact time – both duration and number of sessions - will vary by program.

  15. What Does it Take to Enhance Program Integrity? • Dedicate sufficient time/resources • Integrate program integrity into program operations • Assist outside partners (states, grantees, contractors, etc) in understanding and applying program integrity principles • Each program conducts a risk assessment to identify programmatic vulnerabilities

  16. How Can You Promote Program Integrity Within Your Organization? You can: • Assess the way you perform your job • Look for ways to be more effective and efficient • Suggest areas and innovative ways where the organization can be more effective and efficient • Work with your external partners (e.g., grantees, contractors) • Share your best practices throughout your organization • Ask yourself constantly: “What would I do differently if I were using my own money?”

  17. Questions?

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