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Program Integrity

It is the responsibility of everyone involved to ensure that Federal grant dollars are spent in the way that they are intended. It requires compliance with program expectations, efficient use of Federal funds and fiscal responsibility. 

In 2010, the U.S. Department of Health and Human Services launched a Program Integrity Initiative to reduce improper payments by intensifying efforts to eliminate payment error, waste, fraud, and abuse in the major programs administered by the HHS, while continuing to ensure that HHS programs serve and provide access to their intended beneficiaries.

HRSA provides oversight, guidance and technical assistance to help grantees make certain grant dollars are spent appropriately and waste, fraud and abuse are prevented and detected. 

Reduce Risk

Risk is the potential for failure to achieve a program’s mission and strategic objectives. 

Inappropriate, high-risk behaviors may compromise a grantee's ability to

• Provide services as described in the program plan and agreed to in the Notice of Grant Award. Risks include inability to execute the program or inadequate staffing.
• Manage grant funds to execute the administrative responsibilities of the organization. Risks include lack of fiscal management and control policies, inappropriate use of funds or lack of data to substantiate program activities.
• Maintain oversight authority for the operations of the organization. Risks include inadequate attention to the implementation of the program or lack of a conflict of interest policy.

When a grantee show signs of risk, HRSA works with the organization to

• Develop a plan of action to address the potential risks;
• Increase communication with the project officer;
• Provide technical assistance as needed; and
• Make available other resources to help the grantee

Learn more: Program Integrity Initiative on-demand webcast

Prevent and Detect Fraud, Waste and Abuse

All organizations are at risk for fraud; health care organizations may be at heightened risk. Fraudulent billing, unnecessary services or prescriptions, kickbacks and duplicate claims are just a few of the kinds of schemes that target programs and beneficiaries.

Fraud is a deliberate deception to secure an unfair gain.

Waste is the unnecessary incurrence of costs as a result of inefficient practices, systems or controls.

Abuse is the intentional misuse of authority, position, funds or resources for personal gain.

The consequences of fraud, waste and abuse can range from modification of terms and conditions of award, to drawdown restrictions, to debarment from receiving future funding or even criminal prosecution.

They can be prevented by

• Establishing adequate internal controls;
• Segregating duties;
• Instituting a conflict of interest policy; and
• Maintaining auditable documentation.

Learn more: Fraud, Waste and Abuse on-demand webcast