Federal Reports

This is a management alert on the Business Applications Solution (BAS) program’s approach to business process reengineering, which requires immediate attention, given that the program is in a crucial design phase of the overall effort. The BAS program seeks to modernize the U.S. Department of Commerce’s (the Department’s) legacy financial applications and processes by acquiring commercial off-the-shelf software supported by cloud-based infrastructure. In April 2020, the Department awarded a contract to Accenture Federal Services worth approximately $341 million for fiscal years 2020 through 2040 for services in designing, implementing, migrating, and maintaining a BAS system under a Software-as-a-Service model.The objective of our ongoing audit is to assess the Department’s management and implementation of the BAS program. We are conducting this audit because the BAS program is linked to a Department strategic objective and there are challenges inherent to a large modernization effort.During our fieldwork, we observed that the BAS program lacks plans for business process reengineering and its ongoing process change efforts are not consistent with best practices. These conditions present risk that financial management processes may not be adequately supported by the new BAS system, which could ultimately lead to schedule delays and cost increases. This approach may also miss an opportunity to fundamentally improve how the Department conducts its financial business.

Does the Commission effectively collect, analyze, and review its core infrastructure system security logs?

Under the Medicare Advantage (MA) program, the Centers for Medicare & Medicaid Services (CMS) makes monthly payments to MA organizations according to a system of risk adjustment that depends on the health status of each enrollee. Accordingly, MA organizations are paid more for providing benefits to enrollees with diagnoses associated with more intensive use of health care resources than to healthier enrollees who would be expected to require fewer health care resources.To determine the health status of enrollees, CMS relies on MA organizations to collect diagnosis codes from their providers and submit these codes to CMS. CMS then maps certain diagnosis codes, on the basis of similar clinical characteristics and severity and cost implications, into Hierarchical Condition Categories (HCCs). CMS makes higher payments for enrollees who receive diagnoses that map to HCCs.For this audit, we reviewed one of the contracts that Humana, Inc., has with CMS with respect to the diagnosis codes that Humana submitted to CMS. Our objective was to determine whether Humana submitted diagnosis codes to CMS for use in the risk adjustment program in accordance with Federal requirements.