Major Management Challenges and Program Risks

This publication is part of GAO's performance and accountability series which provides a comprehensive assessment of government management, particularly the management challenges and program risks confronting federal agencies. Using a "performance-based management" approach, this landmark set of reports focuses on the results of government programs--how they affect the American taxpayer--rather than on the processes of government. This approach integrates thinking about organization, product and service delivery, use of technology, and human capital practices into every decision about the results that the government hopes to achieve. The series includes an overview volume discussing governmentwide management issues and 20 individual reports on the challenges facing specific cabinet departments and independent agencies. The reports take advantage of the wealth of new information made possible by management reform legislation, including audited financial statements for major federal agencies, mandated by the Chief Financial Officers Act, and strategic and performance plans required by the Government Performance and Results Act. In a companion volume to this series, GAO also updates its high-risk list of government operations and programs that are particularly vulnerable to waste, fraud, abuse, and mismanagement.

GAO noted that: (1) coordinating the efforts of the numerous administrators of HHS' programs, including its 11 agencies and state and local governments, is critical to ensuring program efficiency and effectiveness; (2) HHS must also coordinate with a number of other federal, state, and local agencies that have programs with similar goals; (3) while HHS recognizes this need, it has not delineated how it plans to ensure effective program coordination; (4) HHS does not have access to the data needed to effectively manage the Department's extensive health insurance programs, grant-making activities, and regulatory responsibilities; (5) developing and maintaining systems to ensure access to such data, however, is challenging since many important HHS programs are administered by program partners, such as state and local governments; (6) yet, without these systems, HHS cannot adequately oversee its programs; (7) maintaining the integrity of HHS' large programs, especially Medicare, continues to be a challenge; (8) although legislation has been enacted in the past 2 years to bolster the Health Care Financing Administration's (HCFA) oversight capacity, initiatives to curb fraud, waste, abuse, and mismanagement have been slow to develop; (9) HHS' Office of the Inspector General reported that HHS and its operating divisions do not have a fully functional integrated financial reporting system capable of producing complete and reliable financial statements in a timely manner; (10) as required by the Government Performance and Results Act of 1993, HHS submitted to Congress a strategic plan for fiscal years 1998-2003; and (11) while this 5-year plan and the Department's 1999 performance plan provide general information about how HHS intends to address these challenges, HHS needs to do more to ensure that its programs achieve intended results and that it is an effective steward of taxpayer dollars.