I N T R O D U C T I O N
Report Template Update: 04-03-08
M M A R YE X E C U T I V E S U
E X E C U T I V E S U M M A R Y
To assess the Centers for Medicare & Medicaid Services’ (CMS)processing of complaints received through the 1-800-HHS-TIPS hotline.
Many Offices of Inspector General (OIG) operate hotlines to respond tocitizen and employee allegations of fraud, waste, or abuse in Federalprograms. The Department of Health & Human Services (HHS) OIGmaintains such a hotline (1-800-HHS-TIPS), for individuals to provideinformation that may assist in combating fraud, waste, or abuse in HHSprograms (e.g., Medicare, Medicaid, child support enforcement, andHead Start). Individuals may call the hotline or send their writtenconcerns by email, postal mail, or fax.We obtained a copy of the hotline complaint data in CMS’s informationsystem as of March 2009. We identified 1,427 complaints that OIGforwarded to CMS in the first 6 months of 2008. From these, weselected a simple random sample of 120 complaints. We telephonedstaff at each contractor assigned to the sampled complaints to inquireabout what initial research the contractor performed to validate eachcomplaint; how and when the contractor contacted the complainant; andwhat outcomes (e.g., recouping an overpayment from the provider)resulted from the contractor’s actions on the complaint. We alsoconducted structured telephone interviews with contractor staff, CMScentral office staff, and CMS regional office staff about the complaintprocess. Finally, to check the status of complaints 1 year after weinitially received the hotline complaint data, in March 2010 we obtaineda copy of the hotline complaint data in CMS’s information system.
At least 1 year after receiving complaints through the1
TIPS hotline, CMS had resolved the majority of them,but 12 percent remained unresolved.
CMS has no requirementsregarding the length of time within which contractors should resolvecomplaints. Our period of review allowed at least 1 year to elapse afterCMS received the complaints from OIG. As of March 2010, interviewswith contractors and a review of data in CMS’s information systemconfirmed that CMS resolved or closed administratively 88 percent of complaints received during the first 6 months of 2008. (Complaints are