Lisa Shellenberger: IHS leaving its patients with unpaid bills

Wednesday, November 9, 2011  

"The Indian Health Service (“IHS”), an agency within the U.S. Department of Health and Human Services, is responsible for providing federal health services to American Indians and Alaska Natives (collectively, “Native Americans”). The IHS provides a purportedly comprehensive health service delivery system for approximately 1.9 million Native Americans. It is becoming clear, however, that funding for the system if far from optimal, and the services do not reach the level of being “comprehensive.” IHS’s goal is “to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people.” However, due to deficiencies in IHS’s oversight of data collection, the agency is falling short in accomplishing this goal.

There are thousands of IHS health care facilities around the country, but many Native Americans require care from outside facilities. The IHS has a program called the Contract Health Services Program (“CHS”), which provides coverage for medical and dental care obtained at non-IHS or tribal health care facilities. The CHS program is vital to the health and well-being for many Native Americans, as it pays for care from non-IHS providers if 1) the patient meets certain requirements and 2) the funding is available. The latter condition has become problematic.

In managing the CHS program, the IHS collects data from the federal and tribal IHS programs on outside services received for which funding was not available. The Patient Protection and Affordable Care Act requires the Government Accountability Office (“GAO”) to study the adequacy of IHS oversight and federal funding for the CHS program. The GAO found that due to deficiencies in IHS’s oversight of data collection on unfunded outside services, the estimate that IHS used to determine the amount of funds needed for the CHS program was not accurate. Because the IHS did not track the data well, the CHS program potentially lost out on significant funds – funds that would have made comprehensive care more of a reality for the IHS system."

Get the Story:
Lisa R. Shellenberger: Deficient Oversight by the Indian Health Service Leaves Money on the Table, Patients Holding the Bag (Smith, Shelton & Ragona Blog 11/9)