Audit is Necessary

Over the past year, my office has been looking into the financial, structural and administrative problems at Indian Health Service (IHS) so that we can better understand how to reform the agency and provide better health care for tribal members. As our tribal members know all too well, the IHS has been failing to live up to its trust responsibility to provide health care to Native Americans. Its shortcomings have been documented in a number of Government Accountability Office (GAO) reports, yet there has never been a systemic review of IHS to address the health care crisis currently going on in the Great Plains Area, which includes South Dakota. Furthermore, IHS fails to adequately consult with the tribes when making decisions about their health care.

I recently requested an audit by the Office of the Inspector General (OIG) at the U.S. Department of Health and Human Services (HHS) to review the financial aspects of hospital and health care, medical services and overall financial management at IHS. Based on my office’s discussions with tribal leaders, we believe an audit is the appropriate first step toward identifying areas of concern and finding solutions to fix the ongoing problems at the agency.

The audit is supported by both tribal members and officials within HHS. The Great Plains Tribal Chairman’s Association recently passed a resolution calling upon Congress to demand an audit of IHS. Additionally, during the Senate Indian Affairs Committee field hearing in Rapid City on June 17, 2016, that I participated in, HHS Acting Deputy Secretary Mary Wakefield said that HHS “would welcome” an audit of IHS.

As I wrote in my request, despite the agency’s well-documented history of failing to meet trust obligations by not providing quality health care, there has never been a systemic review of IHS to address and ultimately reform these issues in attempt to improve health outcomes for tribal members. Furthermore, there has been a continuing lack of consultation with the tribes. I believe an audit – similar to what was recently conducted at the Veterans Health Administration, which identified shortfalls and recommended solutions – is a potential model for addressing these critical financial and quality issues within IHS.

The problems at IHS are serious. The Great Plains Area IHS has the second highest mortality rate among all IHS regions. We also have the highest diabetes death rate, more than triple the average among IHS facilities. Our life expectancy rate is the lowest of all IHS regions, at 68.1 years. The U.S. average life expectancy is nearly a decade longer at 77.7 years. It is clear the IHS is failing our tribal members, who are suffering and in some cases dying due to this inadequate and disgraceful care. We are hopeful that the audit will show us specific areas we can focus on to begin making significant changes.

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