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Recommendations Tracker
HHS-OIG provides independent and objective oversight that promotes economy, efficiency, and effectiveness in HHS programs and operations. To drive positive change, we produce reports and identify recommendations for improvement. We have developed this public-facing page for tracking all of our open recommendations. Learn More
Summary of Recommendations Data
Updated Monthly · Last updated on February 27, 2024
1,322
Unimplemented
recommendations
$276.1B
Potential savingsfrom unimplemented recommendations
2,342
Implemented and Closed
recommendations since FY 2017
OIG Recommendations Grouped by Report
Views
-
Louisiana Should Improve Its Oversight of Nursing Homes' Compliance With Requirements That Prohibit Employment of Individuals With Disqualifying Background Checks
24-A-06-020.01We recommend that the Louisiana Department of Health conduct routine monitoring of nursing homes' compliance with background check requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/28/2024
- Legislative Related
- No
24-A-06-020.02We recommend that the Louisiana Department of Health advise nursing homes to ensure that all background checks are conducted by authorized agencies and include a search of State police records.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/28/2024
- Legislative Related
- No
24-A-06-020.03We recommend that the Louisiana Department of Health advise nursing homes to contractually require staffing companies to conduct background check searches that include State police records and to adjudicate the results of background checks in accordance with Federal and State requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/28/2024
- Legislative Related
- No
24-A-06-020.04We recommend that the Louisiana Department of Health advise nursing homes to verify that contracted employees' background checks are completed in a timely manner and in accordance with applicable requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/28/2024
- Legislative Related
- No
24-A-06-020.05We recommend that the Louisiana Department of Health make training or informational material available to nursing homes on the applicable Federal and State regulations for background checks of employees.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/28/2024
- Legislative Related
- No
-
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That SelectCare of Texas, Inc. (Contract H4506), Submitted to CMS
24-A-06-019.01We recommend that SelectCare of Texas, Inc. refund to the Federal Government the $482,601 in net overpayments- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $482,601
- Last Update Received
- -
- Next Update Expected
- 05/26/2024
- Legislative Related
- No
24-A-06-019.02We recommend that SelectCare of Texas, Inc. identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before and after our audit period and refund any resulting overpayments to the Federal Government- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/26/2024
- Legislative Related
- No
24-A-06-019.03We recommend that SelectCare of Texas, Inc. review its existing compliance procedures to identify potential areas where improvements can be made to ensure that diagnosis codes that are at high risk for being miscoded comply with Federal requirements (when submitted to CMS for use in CMS's risk adjustment program) and take any necessary steps to enhance those current procedures- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/26/2024
- Legislative Related
- No
-
Multiple States Made Medicaid Capitation Payments to Managed Care Organizations After Enrollees' Deaths
24-A-04-018.01We recommend that CMS collect the outstanding unallowable payments totaling the estimated $41,003,804 we previously identified.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/23/2024
- Legislative Related
- No
24-A-04-018.02We recommend that CMS ensure that states complete actions on our remaining recommendations to address the internal control weaknesses we indentified.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/23/2024
- Legislative Related
- No
24-A-04-018.03We recommend that CMS continue to explore opportunities for using T-MSIS and SSA's DMF data to improve its oversight of the Medicaid program. Specifically, CMS should develop a process to match enrollment and payment information in T-MSIS with the DMF and provide the results of that match to States to help reduce Medicaid capitation payments made to MCOs on behalf of deceased enrollees.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/23/2024
- Legislative Related
- No
-
Some of California's Substance Abuse Prevention and Treatment Block Grant Expenditures for Los Angeles County Did Not Comply With Federal and State Requirements
24-A-09-016.01We recommend that the California Department of Health Care Services recover from Los Angeles County $1,681,964 for transitional housing expenditures when closing out the SABG award for our audit period and establish a process to review whether counties, including LA County, were reimbursed for expenditures that had been previously reimbursed.- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Not Yet Due
- Potential Savings
- $1,681,964
- Last Update Received
- -
- Next Update Expected
- 05/16/2024
- Legislative Related
- No
24-A-09-016.02We recommend that the California Department of Health Care Services instruct Los Angeles County to develop a cost allocation plan for its well-being centers, determine the portion of the $1,820,224 that should not have been allocated to the SABG, and recover any overpayment.- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Not Yet Due
- Potential Savings
- $1,820,224
- Last Update Received
- -
- Next Update Expected
- 05/16/2024
- Legislative Related
- No
24-A-09-016.03We also recommend that the California Department of Health Care Services work with Los Angeles County to develop a process to ensure that LA County's claims processing system does not pay transitional housing claims after an individual has been discharged from outpatient treatment.- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/16/2024
- Legislative Related
- No
24-A-09-016.04We also recommend that the California Department of Health Care Services provide clear guidance to providers on claiming and documenting treatment services.- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/16/2024
- Legislative Related
- No
24-A-09-016.05We also recommend that the California Department of Health Care Services develop procedures for LA County's monitoring activities to identify whether providers are submitting invoices for reimbursement based on actual costs incurred.- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/16/2024
- Legislative Related
- No
-
Kentucky Experienced Challenges in Meeting Federal and State Foster Care Program Requirements During the COVID-19 Pandemic
24-A-06-015.01We recommend that Kentucky conduct the name-based checks on the one applicant and one adolescent household member identified by our audit as lacking the required checks and reiterate to staff the importance of adhering to the policies and procedures requiring background checks to be completed before approving foster homes.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/13/2024
- Legislative Related
- No
24-A-06-015.02We recommend that Kentucky conduct FBI fingerprint checks on the five applicants and other household members identified by our audit as lacking completed checks.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/13/2024
- Legislative Related
- No
24-A-06-015.03We recommend that Kentucky identify ways to address the challenges related to meeting the requirements for conducting monthly caseworker visits, including consulting with ACF.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/13/2024
- Legislative Related
- No
-
CMS Can Do More To Leverage Medicare Claims Data To Identify Unreported Incidents of Potential Abuse or Neglect
24-A-01-012.01We recommend that the Centers for Medicare & Medicaid Services conduct data analyses to identify trends and high-risk areas in Medicare claims containing diagnosis codes indicating potential abuse or neglect.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/07/2024
- Legislative Related
- No
24-A-01-012.02We recommend that the Centers for Medicare & Medicaid Services provide the results of the analyses to QIOs and Medicare Program Integrity contractors so that they can conduct targeted claim reviews to identify patterns of unreported incidents of potential abuse or neglect and the reasons the incidents were unreported.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/07/2024
- Legislative Related
- No
24-A-01-012.03We recommend that the Centers for Medicare & Medicaid Services based on the results of the targeted claim reviews, develop and share guidance and best practices with providers to assist providers in reporting incidents in compliance with State mandatory reporting laws.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/07/2024
- Legislative Related
- No
24-A-01-012.04We recommend that the Centers for Medicare & Medicaid Services consider the results of targeted claims reviews when assessing whether the existing requirements for reporting abuse or neglect of Medicare enrollees in provider CoPs should be strengthened.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/07/2024
- Legislative Related
- No
-
Pennsylvania Could Better Ensure That Nursing Homes Comply With Federal Requirements for Life Safety, Emergency Preparedness, and Infection Control
24-A-03-013.01Follow up with the 20 nursing homes reviewed as part of this audit to verify that corrective actions have been taken regarding the life safety, emergency preparedness, and infection control deficiencies identified in this report.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/14/2023
- Next Update Expected
- 06/15/2024
- Legislative Related
- No
24-A-03-013.02Provide annual written reminders to nursing homes with K-tag, F-tag, and E-tag requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/14/2023
- Next Update Expected
- 06/15/2024
- Legislative Related
- No
24-A-03-013.03Work with CMS to develop standardized life safety training for nursing home management teams and staff.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/14/2023
- Next Update Expected
- 06/15/2024
- Legislative Related
- No
24-A-03-013.04Work with CMS to improve standardized emergency plan testing and training for nursing home management teams and staff.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/14/2023
- Next Update Expected
- 06/15/2024
- Legislative Related
- No
24-A-03-013.05Develop additional infection control training resources for nursing home management teams and staff.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/14/2023
- Next Update Expected
- 06/15/2024
- Legislative Related
- No
24-A-03-013.06Work with CMS to refine the current risk-based approach to identify nursing homes at which surveys should be conducted more frequently than once every 15 months, such as those with frequent management turnover.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/14/2023
- Next Update Expected
- 06/15/2024
- Legislative Related
- No
24-A-03-013.07Implement verification standards to confirm completion of written training and training drills.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/14/2023
- Next Update Expected
- 06/15/2024
- Legislative Related
- No
24-A-03-013.08Develop a plan in conjunction with CMS to address the foundational issues preventing more frequent surveys at nursing homes with a history of multiple high-risk deficiencies.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/14/2023
- Next Update Expected
- 06/15/2024
- Legislative Related
- No
-
The Food and Drug Administration Needs To Improve the Premarket Tobacco Application Review Process for Electronic Nicotine Delivery Systems To Protect Public Health
24-A-06-014.01We recommend that the Center for Tobacco Products work with OPM to obtain direct-hire authority to assist CTP in reaching its FTE goal.- Status
- Open Unimplemented
- Responsible Agency
- FDA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/07/2024
- Legislative Related
- No
24-A-06-014.02We recommend that the Center for Tobacco Products assess the PMTA review process and develop an action plan to resolve the backlog of PMTA applications and achieve compliance with the 180-day statutory deadline.- Status
- Open Unimplemented
- Responsible Agency
- FDA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/07/2024
- Legislative Related
- No
-
Noridian Healthcare Solutions Reopened and Corrected Cost Report Final Settlements To Collect $11 Million in Net Overpayments That Had Been Made to Medicare Providers
24-A-06-010.01We recommend that Noridian Healthcare Solutions develop and deliver additional education to auditors and audit supervisors regarding applicable criteria and review requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/05/2024
- Legislative Related
- No
24-A-06-010.02We recommend that Noridian Healthcare Solutions develop and implement procedures to allow enough time for adequate auditor and supervisory review of audit adjustments and related actions.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/05/2024
- Legislative Related
- No
24-A-06-010.03We recommend that Noridian Healthcare Solutions develop and implement enhanced procedures so that supervisors and higher-level reviewers are better qualified to detect incorrect audit adjustments.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/05/2024
- Legislative Related
- No
-
HHS's Oversight of Automatic Provider Relief Fund Payments Was Generally Effective but Improvements Could Be Made
24-A-02-011.01We recommend that the Health Resources and Services Administration perform postpayment reviews of 108 renal dialysis providers that attested to and kept automatic PRF payments totaling $58 million and recoup any outstanding overpayments from these providers.- Status
- Open Unimplemented
- Responsible Agency
- HRSA
- Response
- Not Yet Due
- Potential Savings
- $57,506,123
- Last Update Received
- -
- Next Update Expected
- 04/29/2024
- Legislative Related
- No
24-A-02-011.02We recommend that the Health Resources and Services Administration perform postpayment reviews of 58 providers with multiple subsidiary organizations that attested to and kept automatic PRF payments totaling $130 million and recoup any outstanding overpayments from these providers.- Status
- Open Unimplemented
- Responsible Agency
- HRSA
- Response
- Not Yet Due
- Potential Savings
- $130,044,256
- Last Update Received
- -
- Next Update Expected
- 04/29/2024
- Legislative Related
- No
24-A-02-011.03We recommend that the Health Resources and Services Administration perform postpayment reviews of 642 providers that attested to and kept $165 million in automatic PRF payments for which they were not eligible and recoup any outstanding overpayments from these providers.- Status
- Open Unimplemented
- Responsible Agency
- HRSA
- Response
- Not Yet Due
- Potential Savings
- $164,642,600
- Last Update Received
- -
- Next Update Expected
- 04/29/2024
- Legislative Related
- No
24-A-02-011.04We recommend that the Health Resources and Services Administration commit to strengthening its procedures that may apply to future programs of a similar nature to better ensure that; providers receive their intended share of financial assistance; financial assistance payments are properly calculated; data and data sources are appropriate, current, complete, and accurate, and revisions are made when necessary for calculating financial assistance; and all available data sources are utilized to identify ineligible providers and prevent them from receiving financial assistance.- Status
- Open Unimplemented
- Responsible Agency
- HRSA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/29/2024
- Legislative Related
- No
-
Medicare Advantage Compliance Audit of Diagnosis Codes That CarePlus Health Plans, Inc. (Contract H1019) Submitted to CMS
24-A-04-008.01We recommend that CarePlus Health Plans, Inc. refund to the Federal Government the $641,467 of net overpayments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $641,467
- Last Update Received
- -
- Next Update Expected
- 04/25/2024
- Legislative Related
- No
24-A-04-008.02We recommend that CarePlus Health Plans, Inc. ensure that its policies and procedures have been adequately designed and implemented to prevent, detect, and correct noncompliance with Federal requirements for diagnosis codes that are used to calculate risk-adjusted payments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/25/2024
- Legislative Related
- No
-
New York City Department of Health and Mental Hygiene Charged Some Unallowable Costs to Its CDC COVID-19 Award
24-A-04-009.01We recommend that NYC DOHMH refund $15,671,958 to the Federal government.- Status
- Open Unimplemented
- Responsible Agency
- CDC
- Response
- Not Yet Due
- Potential Savings
- $15,671,958
- Last Update Received
- -
- Next Update Expected
- 04/25/2024
- Legislative Related
- No
24-A-04-009.02We recommend that NYC DOHMH strengthen its oversight of subrecipients to prevent future unallowable payments by reviewing subrecipient invoices and supporting documentation to ensure costs claimed are allowable and allocable.- Status
- Open Unimplemented
- Responsible Agency
- CDC
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/25/2024
- Legislative Related
- No
-
CDC's Internal Control Weaknesses Led to Its Initial COVID-19 Test Kit Failure, but CDC Ultimately Created a Working Test Kit
24-A-04-007.01We recommend that the Centers for Disease Control and Prevention create policies and procedures for developing test kits that include roles, responsibilities, and oversight.- Status
- Open Unimplemented
- Responsible Agency
- CDC
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2024
- Legislative Related
- No
24-A-04-007.02We recommend that the Centers for Disease Control and Prevention ensure that the recently finalized GRF addresses the findings we identified in this report.- Status
- Open Unimplemented
- Responsible Agency
- CDC
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2024
- Legislative Related
- No
24-A-04-007.03We recommend that the Centers for Disease Control and Prevention develop and implement documented processes to ensure that adequate staffing and laboratory space can be obtained for future responses and provide for separation of duties and supervisor controls.- Status
- Open Unimplemented
- Responsible Agency
- CDC
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2024
- Legislative Related
- No
24-A-04-007.04We recommend that CDC re-evaluate the IMS structure at all levels of CDC's response framework and integrate positions or roles and responsibilities that provide effective oversight of a response effort, including a laboratory-based response effort.- Status
- Open Unimplemented
- Responsible Agency
- CDC
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2024
- Legislative Related
- No
24-A-04-007.05We recommend CDC implement a CDC-wide laboratory document control system.- Status
- Open Unimplemented
- Responsible Agency
- CDC
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2024
- Legislative Related
- No
24-A-04-007.06We recommend that CDC ensure that all infectious disease laboratories implement and periodically evaluate a QMS.- Status
- Open Unimplemented
- Responsible Agency
- CDC
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2024
- Legislative Related
- No
-
States Face Ongoing Challenges in Meeting Third-Party Liability Requirements for Ensuring That Medicaid Functions as the Payer of Last Resort
24-A-05-006.01We recommend that the Centers for Medicare & Medicaid Services use the information we obtained from States about the challenges they are still encountering and develop an action plan for helping States more easily identify liable third parties and recover Medicaid payments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/19/2024
- Legislative Related
- No
24-A-05-006.02We recommend that the Centers for Medicare & Medicaid Services work with States, as appropriate, to encourage better cooperation from third parties that routinely resist States' TPL identification and recovery efforts.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/19/2024
- Legislative Related
- No
24-A-05-006.03We recommend that the Centers for Medicare & Medicaid Services, for the four States we identified as not having fully complied with the DRA's TPL provisions, verify whether the States have since come into compliance; and pursue corrective actions for States that have not fully complied.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/19/2024
- Legislative Related
- No
24-A-05-006.04We recommend that the Centers for Medicare & Medicaid Services verify whether Virginia has refunded the $1.25 million Federal share of the Medicaid TPL collections underreported during two fiscal quarters and, if not, require Virginia to refund any remaining amount owed.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $1,245,924
- Last Update Received
- -
- Next Update Expected
- 04/19/2024
- Legislative Related
- No
24-A-05-006.05We recommend that the Centers for Medicare & Medicaid Services provide guidance to States to assist them with developing processes that improve the reporting of Medicaid TPL amounts on the form 64.9A.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/19/2024
- Legislative Related
- No
24-A-05-006.06We recommend that the Centers for Medicare & Medicaid Services ensure that States have current instructions on completing the form 64.9A.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/19/2024
- Legislative Related
- No
24-A-05-006.07We recommend that the Centers for Medicare & Medicaid Services ensure that States correctly report TPL amounts on the form 64.9A.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/19/2024
- Legislative Related
- No
24-A-05-006.08We recommend that the Centers for Medicare & Medicaid Services remove or disable lines from the form 64.9A that States are supposed to leave blank.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/19/2024
- Legislative Related
- No
-
South Dakota MMIS and E&E System Security Controls Were Partially Effective and Improvements Are Needed
24-A-18-005.01We recommend that the South Dakota Department of Social Services remediate the six control findings OIG identified.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 02/09/2024
- Next Update Expected
- 08/09/2024
- Legislative Related
- No
-
Mississippi Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations
24-A-07-004.01We recommend that the Mississippi Division of Medicaid work with CMS to calculate the rebate amount for claims identified in our findings, invoice drug manufacturers for the calculated rebates, and refund the Federal share of rebates collected for the years covered by our audit period and for years after our audit period.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $13,707,201
- Last Update Received
- -
- Next Update Expected
- 04/17/2024
- Legislative Related
- No
24-A-07-004.02We recommend that the Mississippi Division of Medicaid strengthen internal controls to facilitate the invoicing of all physician-administered drugs for rebate.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/17/2024
- Legislative Related
- No
-
The Strategic National Stockpile Was Not Positioned To Respond Effectively to the COVID-19 Pandemic
24-A-04-003.01We recommend that ASPR mitigate the risk presented by relying on foreign supply chains and JIT inventory strategies when determining annual Stockpile purchases.- Status
- Open Unimplemented
- Responsible Agency
- ASPR
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/15/2024
- Legislative Related
- No
24-A-04-003.02We recommend that ASPR develop a strategic plan for the Stockpile, that clearly defines the goals and objectives of the Stockpile, and the Stockpile's roles and responsibilities for responding to emergency events, including pandemics.- Status
- Open Unimplemented
- Responsible Agency
- ASPR
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/15/2024
- Legislative Related
- No
24-A-04-003.03We recommend that ASPR work to increase the Stockpile's annual funding to keep pace with the Stockpile's increased responsibilities.- Status
- Open Unimplemented
- Responsible Agency
- ASPR
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/15/2024
- Legislative Related
- Yes
24-A-04-003.04We recommend that ASPR reinstate the annual planning and review process and issue to Congress an updated PHEMCE SIP, PHEMCE Multiyear Budget, and Stockpile Annual Review Report.- Status
- Open Unimplemented
- Responsible Agency
- ASPR
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/15/2024
- Legislative Related
- No
24-A-04-003.05We recommend that ASPR develop a plan and timeline for fully integrating the Stockpile within ASPR.- Status
- Open Unimplemented
- Responsible Agency
- ASPR
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/15/2024
- Legislative Related
- No
24-A-04-003.06We recommend that ASPR develop a response plan, to include communication plans, for situations in which the Stockpile needs to respond to changes in roles and responsibilities during large-scale emergency responses.- Status
- Open Unimplemented
- Responsible Agency
- ASPR
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/15/2024
- Legislative Related
- No
-
Medicare Could Save Millions if It Implements an Expanded Hospital Transfer Payment Policy for Discharges to Postacute Care
24-A-01-002.01We recommend that CMS conduct an analysis of its hospital transfer payment policy for discharges to PAC and expand the policy as necessary.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $694,000,000
- Last Update Received
- -
- Next Update Expected
- 04/05/2024
- Legislative Related
- No
-
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Aetna, Inc. (Contract H5521) Submitted to CMS
24-A-01-001.01We recommend that Aetna, Inc. refund to the Federal Government the $632,070 of overpayments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $632,070
- Last Update Received
- -
- Next Update Expected
- 04/01/2024
- Legislative Related
- No
24-A-01-001.02We recommend that Aetna, Inc. determine, for the remaining 159 enrollee-years in the potentially mis-keyed diagnosis code high-risk group not reviewed as part of this audit, whether the medical records in each case support the diagnosis for the unrelated condition and refund any resulting overpayments to the Federal Government.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/01/2024
- Legislative Related
- No
24-A-01-001.03We recommend that Aetna, Inc. identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before or after our audit period and refund any resulting overpayments to the Federal Government.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/01/2024
- Legislative Related
- No
24-A-01-001.04We recommend that Aetna, Inc. continue to examine its existing compliance procedures to identify areas where improvements can be made to ensure that diagnosis codes that are at high risk for being miscoded comply with Federal requirements (when submitted to CMS for use in CMS's risk adjustment program) and take the necessary steps to enhance those procedures.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/01/2024
- Legislative Related
- No
-
New Jersey Could Better Ensure That Nursing Homes Comply With Federal Requirements for Life Safety, Emergency Preparedness, and Infection Control
23-A-02-127.01We recommend that the New Jersey Department of Health follow up with the 20 nursing homes reviewed in this audit that demonstrated life safety, emergency preparedness, and infection control deficiencies to ensure that they have taken corrective actions.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/31/2024
- Legislative Related
- No
23-A-02-127.02We recommend that the New Jersey Department of Health instruct all nursing homes to install carbon monoxide detectors in accordance with New Jersey requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/31/2024
- Legislative Related
- No
23-A-02-127.03We recommend that the New Jersey Department of Health work with CMS to develop a risk-based approach to identify nursing homes where surveys should be conducted more frequently than once every 15 months, such as those with a history of multiple high-risk deficiencies or frequent management turnover.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/31/2024
- Legislative Related
- No
23-A-02-127.04We recommend that the New Jersey Department of Health work with CMS to develop a plan to address the foundational issues preventing more frequent surveys at nursing homes with a history of multiple high-risk deficiencies.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/31/2024
- Legislative Related
- No
23-A-02-127.05We recommend that the New Jersey Department of Health work with CMS to develop standardized life safety training for nursing home staff.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/31/2024
- Legislative Related
- No