Recommendations Tracker
HHS-OIG provides independent and objective oversight that promotes economy, efficiency, and effectiveness in HHS programs and operations. To drive this positive change, we produce reports and identify recommendations for improvement. We have developed this public-facing page for tracking all of our open recommendations.
Use the Top Unimplemented View below to read OIG's Top Unimplemented Recommendations. In OIG’s view, these top recommendations for HHS programs, if implemented, would have the greatest impact in terms of cost savings, program effectiveness and efficiency, and public health and safety. Learn more
Summary of All Recommendations
Updated Monthly · Last updated on November 14, 2025
1,188
Unimplemented
recommendations
3,135
Implemented and Closed
recommendations since FY 2017
Views
OIG Recommendations Grouped by Report
Showing 1–20 of 1,340 reports, containing 4,323 recommendations
Sorted by latest release date
-
Pennsylvania Correctly Invoiced Rebates to Manufacturers for Most Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations
26-A-03-009.01We recommend that the Pennsylvania Department of Human Services invoice for and collect from manufacturers rebates totaling $488,051 ($284,617 Federal share) for single-source and top-20 multiple-source physician-administered drugs and refund the Federal share of rebates collected.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $284,617
- Last Update Received
- -
- Next Update Expected
- 05/04/2026
- Legislative Related
- No
26-A-03-009.02We recommend that the Pennsylvania Department of Human Services continue to review exclusion reports and invoice manufacturers for rebate-eligible drugs dispensed after our audit period.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/04/2026
- Legislative Related
- No
26-A-03-009.03We recommend that the Pennsylvania Department of Human Services update its policies and procedures to require steps to regularly review exclusion reports for rebate eligible NDCs, and invoice for rebate those drugs identified as rebate eligible.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/04/2026
- Legislative Related
- No
-
Texas' Ambulance Services Supplemental Payment Program Did Not Comply With Federal and State Reimbursement Requirements
26-A-06-008.01We recommend that the Texas Department of Health and Human Services require training for all individuals that certify ASSPP cost reports on how to review cost reports for accuracy.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/04/2026
- Legislative Related
- No
26-A-06-008.02We recommend that the Texas Department of Health and Human Services revise its policies and procedures to require ambulance providers to submit sufficient documentation that allows the State agency to determine whether costs claimed on ASSPP cost reports are related to the provision of contracted patient care.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/04/2026
- Legislative Related
- No
-
South Carolina Did Not Comply With Federal Waiver and State Requirements at 19 of 20 Adult Day Care Facilities
26-A-04-007.01We recommend that the South Carolina Department of Health and Human Services work with the South Carolina Department of Public Health to ensure that providers correct the 204 instances of provider noncompliance identified in this report.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 11/14/2025
- Next Update Expected
- 04/28/2026
- Legislative Related
- No
26-A-04-007.02We recommend that the South Carolina Department of Health and Human Services improve its oversight and monitoring of providers.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 11/14/2025
- Next Update Expected
- 04/28/2026
- Legislative Related
- No
26-A-04-007.03We recommend that the South Carolina Department of Health and Human Services work with providers to improve their facilities, staffing, and training.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 11/14/2025
- Next Update Expected
- 04/28/2026
- Legislative Related
- No
-
Medicare Improperly Paid Suppliers $22.7 Million Over 7 Years for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided to Enrollees During Inpatient Stays
26-A-09-006.01We recommend that the Centers for Medicare & Medicaid Services direct the DME MACs to recover from suppliers up to $22,671,778 in identified improper payments for our audit period that are within the 4-year reopening period in accordance with CMS's policies and procedures.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $22,671,778
- Last Update Received
- -
- Next Update Expected
- 04/23/2026
- Legislative Related
- No
26-A-09-006.02We recommend that the Centers for Medicare & Medicaid services direct the DME MACs to recommend that the suppliers refund to enrollees up to $5,853,922 in deductible and coinsurance amounts that may have been incorrectly collected from them or from someone on their behalf.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2026
- Legislative Related
- No
26-A-09-006.03We recommend that the Centers for Medicare & Medicaid Services instruct the DME MACs to notify, as CMS deems appropriate, suppliers that received an overpayment or overpayments to consider conducting one or more internal audits or investigations based on the risks identified by this audit to identify any similar overpayments the supplier might have received and return any identified overpayments to the Medicare program.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2026
- Legislative Related
- No
26-A-09-006.04We recommend that the Centers for Medicare & Medicaid Services identify any DMEPOS claims after our audit period for items provided to enrollees during inpatient stays and direct the DME MACs to recover any improper payments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2026
- Legislative Related
- No
26-A-09-006.05We recommend that the Centers for Medicare & Medicaid Services review system edits to determine whether any refinements are necessary to prevent improper payments to suppliers for DMEPOS items provided to enrollees during inpatient stays.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2026
- Legislative Related
- No
-
CMS’s Special Focus Facility Program for Nursing Homes Has Not Yielded Lasting Improvements
26-E-01-004.01CMS should impose more nonfinancial enforcement remedies that encourage sustained compliance.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2026
- Legislative Related
- No
26-E-01-004.02CMS should assess the extent to which it took enhanced enforcement actions for SFF graduates and the effectiveness of those actions, particularly for graduates that received a deficiency for staffing.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2026
- Legislative Related
- No
26-E-01-004.03CMS should incorporate nursing home ownership information into the SFF program, such as in selecting SFFs and identifying patterns of poor performance.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2026
- Legislative Related
- No
-
Medicare Home Health Agency Provider Compliance Audit: VNA Care Network
26-A-05-005.01We recommend that VNA Care Network refund the $6,171 in overpayments to the Medicare program.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $6,171
- Last Update Received
- -
- Next Update Expected
- 04/22/2026
- Legislative Related
- No
26-A-05-005.02We recommend that VNA Care Network consider conducting one or more internal audits or investigations for claims before and after our audit period based on the risks identified by this audit to identify any similar overpayments the provider might have received and return any identified overpayments to the Medicare program.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/22/2026
- Legislative Related
- No
26-A-05-005.03We recommend that VNA Care Network strengthen its review processes for identification of inaccuracies in medical record documentation to improve compliance with Medicare billing requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/22/2026
- Legislative Related
- No
-
Connecticut Could Better Ensure That Intermediate Care Facilities for Individuals With Intellectual Disabilities Comply With Federal Requirements for Life Safety, Emergency Preparedness, and Infection Control
26-A-01-004.01We recommend that the Connecticut Department of Public Health follow up with the 15 ICF/IIDs reviewed to verify that they have taken corrective actions on the life safety, emergency preparedness, and infection control deficiencies identified during the audit.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/20/2026
- Legislative Related
- No
26-A-01-004.02We recommend that the Connecticut Department of Public Health work with CMS to develop standardized life safety training for ICF/IID staff.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/20/2026
- Legislative Related
- No
-
Indiana Did Not Fully Comply With Federal Waiver and State Health, Safety, and Administrative Requirements at 30 Residential Settings
26-A-05-002.01We recommend that the Indiana Family and Social Services Administration work with residential providers to correct the 246 instances of provider noncompliance identified in this report.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/08/2026
- Legislative Related
- No
26-A-05-002.02We recommend that the Indiana Family and Social Services Administration improve its oversight and monitoring of residential providers.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/08/2026
- Legislative Related
- No
26-A-05-002.03We recommend that the Indiana Family and Social Services Administration work with the residential providers to improve internal controls for health and safety at residential settings, maintenance of records, and training.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/08/2026
- Legislative Related
- No
-
Many Medicare Advantage and Medicaid Managed Care Plans Have Limited Behavioral Health Provider Networks and Inactive Providers
26-E-02-002.01CMS should use data to monitor provider networks and take additional steps to improve the accuracy of network directories in Medicare Advantage.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/01/2026
- Legislative Related
- No
26-E-02-002.02CMS should work with States to improve the accuracy of network directories in Medicaid managed care.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/01/2026
- Legislative Related
- No
26-E-02-002.03CMS should continue exploring how a nationwide directory could reduce inaccuracies and increase administrative efficiencies for providers and patients.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/01/2026
- Legislative Related
- No
-
Vermont Medicaid Fraud Control Unit: 2024 Inspection
26-E-07-001.01Build upon its efforts to increase fraud referrals from relevant partners- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/01/2026
- Legislative Related
- No
26-E-07-001.02Implement a comprehensive case management system that allows the Unit to efficiently access, maintain, and report case information and performance data- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/01/2026
- Legislative Related
- No
26-E-07-001.03Develop and implement a plan to improve communication and coordination with OIG and other Federal partners- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/01/2026
- Legislative Related
- No
26-E-07-001.04Take steps to report all adverse actions to Federal partners within the appropriate timeframes- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/01/2026
- Legislative Related
- No
-
Medicare Could Have Saved $301.5 Million if Bundled Payment Rates for Opioid-Use-Disorder Treatment Services Had Reflected Services Provided to Enrollees
26-A-09-001.01We recommend that the Centers for Medicare & Medicaid Services take the following actions to align its bundled payment rates with OUD treatment services provided to enrollees during an episode of care, which could have saved Medicare an estimated $301,479,659 during our audit period, use the results of our audit or gather additional information on the combination of OUD treatment services and the frequency of each type of treatment service provided to Medicare enrollees, and consider revising its methodology for determining the nondrug component of the weekly bundled payment rates.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/01/2026
- Legislative Related
- No
26-A-09-001.02We recommend that the Centers for Medicare & Medicaid Services take the following actions to align its bundled payment rates with OUD treatment services provided to enrollees during an episode of care, which could have saved Medicare an estimated $301,479,659 during our audit period, consider developing, within its statutory authority, additional HCPCS codes for the weekly bundles (e.g., codes reflecting services provided at lower frequencies).- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/01/2026
- Legislative Related
- No
26-A-09-001.03We recommend that the Centers for Medicare & Medicaid Services work with SAMHSA (or a designated agency) to perform monitoring activities to ensure OTPs have properly documented OUD treatment services in enrollees' treatment plans.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/01/2026
- Legislative Related
- No
-
California Met Some Requirements of the Projects for Assistance in Transition From Homelessness Program but Did Not Accurately Report Program Activities for Selected Providers
25-A-09-126.01We recommend that the California Department of Health Care Services work with relevant parties to provide guidance and training to PATH providers to accurately report data in the PATH Annual Report, especially the number of consumers enrolled in its PATH program and the total amount for Federal and non-Federal contributions.- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/28/2026
- Legislative Related
- No
25-A-09-126.02We recommend that the California Department of Health Care Services strengthen its oversight of the PATH program by validating that PATH providers adequately document services provided to and contacts made with consumers (e.g., by periodically performing reviews of providers' case file documentation).- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/28/2026
- Legislative Related
- No
-
The National Institutes of Health Needs to Improve the Cybersecurity of the All of Us Research Program to Protect Participant Data
25-A-18-127.01We recommend that NIH require the DRC awardee to implement access controls to prevent DRC and DRC-RW information systems users from accessing the systems while abroad without verified approval.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/28/2026
- Legislative Related
- No
25-A-18-127.02We recommend that NIH require the DRC awardee to identify and implement a control or compensating control to prevent the downloading of detailed participant data, as required by the All of Us Data Use Policies.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/28/2026
- Legislative Related
- No
25-A-18-127.03We recommend that NIH formally communicate national security concerns related to maintaining genomic data to All of Us award recipients that use or maintain genomic data and require the implementation of the IT security and privacy controls to protect the storage, transmission, and processing of such data.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/28/2026
- Legislative Related
- No
25-A-18-127.04We recommend that NIH require the DRC awardee to reevaluate the security categorization for the DRC and DRC-RW information systems considering the national security concerns of maintaining genomic data.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/28/2026
- Legislative Related
- No
25-A-18-127.05We recommend that NIH require the DRC awardee to update the remediation timeframe in its system security plans to comply with the timeframes specified in its award agreement with NIH.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/28/2026
- Legislative Related
- No
-
West Virginia Did Not Comply With Intake, Screening, Assessment, and Investigation Requirements for Responding to Reports of Child Abuse and Neglect
25-A-01-124.01We recommend that the West Virginia Department of Human Services, Bureau for Social Services take appropriate steps to ensure child welfare workers perform all required procedures within the intake assessment and the initial assessment processes as required.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/25/2026
- Legislative Related
- No
25-A-01-124.02We recommend that the West Virginia Department of Human Services, Bureau for Social Services provide training to supervisors on the requirement to notify mandated reporters of whether the referral was accepted for assessment or screened out.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/25/2026
- Legislative Related
- No
25-A-01-124.03We recommend that the West Virginia Department of Human Services, Bureau for Social Services develop a new system edit to prevent an incorrect safety assessment decision based on the impending safety threats selected.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/25/2026
- Legislative Related
- No
25-A-01-124.04We recommend that the West Virginia Department of Human Services, Bureau for Social Services develop written policies and procedures that include a requirement for supervisors to monitor child welfare worker progress to ensure interviews with children and adults are conducted as required; and aging reports on a weekly basis to promptly identify delays in closing out the initial assessment within 30 days as required.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/25/2026
- Legislative Related
- No
-
Hospitals Charged CMS for Trauma Team Activations That Did Not Comply With Federal Requirements
25-A-01-123.01We recommend that the Centers for Medicare & Medicaid Services take the necessary steps to address the estimated $2.4 billion in unallowable trauma team activation charges reported on hospitals' cost reports and the resulting incorrect outlier payments to improve the accuracy of data used to establish future PPS payment rates.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/22/2026
- Legislative Related
- No
25-A-01-123.02We recommend that the Centers for Medicare & Medicaid Services work with the MACs to identify similar instances of noncompliance that occurred after our audit period to determine and address the impact to the Federal Government related to claims for trauma team activation that did not comply with Federal requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/22/2026
- Legislative Related
- No
25-A-01-123.03We recommend that the Centers for Medicare & Medicaid Services revise CMS guidance to explain when trauma team activation is reasonable and necessary (e.g., by incorporating ACS trauma center requirements and, if necessary, providing specific examples).- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/22/2026
- Legislative Related
- No
25-A-01-123.04We recommend that the Centers for Medicare & Medicaid Services provide more frequent education to hospitals on CMS requirements for submitting claims with trauma team activation.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/22/2026
- Legislative Related
- No
-
Deficiencies With Incorporating Required Cybersecurity Language in HHS Contracts and Timeliness of Contractor Incident Reporting
25-A-18-122.01We recommend that the Department of Health and Human Services Office of the Chief Information Officer require OpDivs to modify any ICT service contracts that lack required security language, including the required language as stated in the HHS Policy for Information Technology Procurements – Security and Privacy Language.- Status
- Open Unimplemented
- Responsible Agency
- OS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/21/2026
- Legislative Related
- No
25-A-18-122.02We recommend that the Department of Health and Human Services Office of the Chief Information Officer implement a verification step in the procurement process to confirm that all ICT service contracts include the required security language pertaining to incident reporting before awarding the contracts.- Status
- Open Unimplemented
- Responsible Agency
- OS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/21/2026
- Legislative Related
- No
-
Seventeen of Twenty-Five Selected Hospitals Did Not Comply or May Not Have Complied With the Provider Relief Fund Balance Billing Requirement
25-A-02-121.01We recommend that the Health Resources and Services Administration determine whether the selected hospitals made refunds to the patients identified in this audit for billings that did not or may not have complied with the PRF balance billing requirement.- Status
- Open Unimplemented
- Responsible Agency
- HRSA
- Response
- Not Yet Due
- Potential Savings
- $637,035
- Last Update Received
- -
- Next Update Expected
- 03/18/2026
- Legislative Related
- No
25-A-02-121.02We recommend that the Health Resources and Services Administration as part of its established and ongoing program integrity procedures, perform postpayment reviews of hospitals for compliance with the balance billing requirement, including the hospitals we identified that may not have complied, to ensure that patients were not billed more than their in-network amount and were refunded any improper billed amounts.- Status
- Open Unimplemented
- Responsible Agency
- HRSA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/18/2026
- Legislative Related
- No
-
New Jersey Did Not Ensure That Some Medicaid Personal Care Assistant Services Provided Under the Personal Preference Program Met Federal and State Requirements
25-A-02-119.01We recommend that the New Jersey Department of Human Services improve its oversight and monitoring of its New Jersey Medicaid PPP by requiring MCOs to revise their procedures to include: (1) maintaining PCA assessments, (2) completing PCA reassessments annually, (3) maintaining monthly budget amounts, and (4) updating monthly budget amounts in accordance with applicable PCA assessments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/16/2026
- Legislative Related
- No
25-A-02-119.02We recommend that the New Jersey Department of Human Services improve its oversight and monitoring of its New Jersey Medicaid PPP by requiring the fiscal intermediary to revise its procedures to include: (1) documenting participants' cash plans, (2) populating accurate information on cash plans, (3) documenting all services to be provided in participants' cash plans, and (4) completing and documenting OIG LEIE verifications for caregivers.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/16/2026
- Legislative Related
- No
-
Texas Did Not Calculate or Collect Hospice Cap Overpayments Totaling $10.5 Million
25-A-06-120.01We recommend that the Texas Health and Human Services Commission collect the hospice cap overpayments totaling $10,498,423 and refund the Federal share of $6,916,454 to the Federal Government.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $6,916,454
- Last Update Received
- -
- Next Update Expected
- 03/16/2026
- Legislative Related
- No
25-A-06-120.02We recommend that the Texas Health and Human Services Commission develop and implement policies and procedures related to calculating and collecting hospice cap overpayments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/16/2026
- Legislative Related
- No
-
Puerto Rico Medicaid Fraud Control Unit: 2024 Onsite Review
25-E-06-039.01Build upon its efforts to increase referrals from managed care organizations.- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/10/2026
- Legislative Related
- No
25-E-06-039.02Update its electronic case management system to address the system's limitations and provide further training on the system to Unit staff.- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/10/2026
- Legislative Related
- No
25-E-06-039.03Implement a process to ensure that periodic supervisory case file reviews are conducted and documented on a consistent basis.- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/10/2026
- Legislative Related
- No
25-E-06-039.04Take steps to ensure that it reports all convictions and adverse actions to Federal partners within the appropriate timeframes.- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 03/10/2026
- Legislative Related
- No