“OIG's Top Unimplemented Recommendations: Solutions To Reduce Fraud, Waste, and Abuse in HHS Programs”, an annual publication from HHS-OIG.
In this edition, we focus on the top 25 unimplemented recommendations that, in OIG’s view, would most positively affect HHS programs in terms of cost savings, program effectiveness and efficiency, and public health and safety if implemented.
* - These recommendations appear on OIG’s Top 25 list for the first time in this edition.
- CMS should take actions to ensure that incidents of potential abuse or neglect of Medicare and Medicaid beneficiaries, including those in nursing homes and hospice care as well as children enrolled in Medicaid, are identified and reported.
- CMS should address inappropriate nursing home discharges through training, by implementing deferred initiatives, and by assessing the effectiveness of its enforcement against inappropriate facility-initiated discharges.*
- CMS should take steps to reduce the costs for Medicare and its beneficiaries by promoting the use of less costly, clinically appropriate drugs.
- CMS should improve and implement system edit processes for its durable medical equipment (DME) Medicare contractors to prevent improper payments for services provided to hospice beneficiaries.*
- CMS should take the necessary steps to establish an inpatient rehabilitation facility (IRF) transfer payment policy for early discharges to home health care and reevaluate the IRF payment system, which could include seeking legislative authority to make any changes necessary to more closely align IRF payment rates and costs.
- CMS should seek legislative authority to comprehensively reform the hospital wage index system.
- CMS should recover overpayments of $1 billion resulting from incorrectly assigning severe malnutrition diagnosis codes to inpatient hospital claims, ensure that hospitals bill appropriately moving forward, and conduct targeted reviews of claims at the highest severity level that are vulnerable to upcoding.
- CMS should take steps to increase access to treatments for opioid use disorder.
- CMS should monitor and provide targeted oversight for Medicare Advantage Organizations (MAOs) that had a disproportionate share of risk-adjusted payments from chart reviews and health reimbursement arrangements (HRAs).
- CMS should require MAOs to submit and encourage MAOs to provide program oversight based on an ordering provider’s national provider identifier (NPI) on encounter records for DME, prosthetics, orthotics, and supplies, as well as for laboratory, imaging, and home health services.
- CMS should develop and execute a strategy to ensure that Part D does not pay for drugs that should be covered by the Part A hospice benefit.
- CMS should ensure that States’ reporting of national Medicaid data is complete, accurate, and timely.
- CMS should monitor national performance data for blood lead screening tests for children and target efforts toward low-performing States to develop action plans for increasing the provision of blood lead screening tests.*
- CMS should develop policies and procedures to improve the timeliness of recovering Medicaid overpayments and recover uncollected amounts identified by OIG’s audits.
- CMS should improve Medicaid managed care organizations’ (MCOs’) identifications and referrals of cases of suspected fraud or abuse.
- CMS should identify States with limited availability of behavioral health services and develop strategies and share information to ensure that Medicaid managed care enrollees have timely access to these services.
- ACF should improve access to appropriate mental health treatment services for unaccompanied children and take all reasonable steps to minimize the amount of time that they remain in ORR’s custody.
- ACF and HHS should improve their operational, management, and communication systems to better address the safety and security needs of unaccompanied children.
- ACF should develop a comprehensive strategy to improve States’ compliance with requirements related to treatment planning and medication monitoring for children in foster care who are prescribed psychotropic medication.
- As a management priority, IHS should develop and implement a staffing program for recruiting, retaining, and transitioning staff and leadership to remote hospitals.
- NIH should continue to build on its efforts to identify and mitigate potential foreign threats to research integrity.
- FDA should improve its use of Risk Evaluation and Mitigation Strategies (REMS) by enhancing the assessment review process, ensuring that assessment reviews are timely, and strengthening REMS to better address the opioid crisis.
- HHS should ensure it has effective response plans and provides necessary guidance to effectively respond to domestic and international public health emergencies.
- HHS should improve administration and management of contracts related to inherently governmental functions and personal services. HHS should also provide training to political appointees and senior leaders related to contract administration.
- HHS should ensure that cybersecurity incident response capabilities are fully implemented across the Department.