Recommendations Tracker

We recommend that the Massachusetts Department of Public 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.

We recommend that the Massachusetts Department of Public 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.

We recommend that the Department of Health and Human Services fulfill the remaining seven covered agency responsibilities established in GDA section 759(a).

We recommend that the Department of Health and Human Services develop and maintain an inventory of all geospatial data assets in accordance with section 759(b) of the GDA.

CMS should take steps to confirm that all States cover required services from maternal health providers for Medicaid managed care enrollees.

CMS should support States in tailoring their network adequacy standards to better address maternal health care needs.

We recommend that EmblemHealth refund to the Federal Government the $551,917 of net overpayments.

We recommend that the Indian Health Service work with Gallup Indian Medical Center and the Navajo Area Office to take action to complete background investigations, including adjudication, for staff members identified in this report as not having a satisfactory background investigation.

We recommend that the Indian Health Service work with Gallup Indian Medical Center and the Navajo Area Office to update standard operating procedures for background investigations to include completing background investigations for temporary staff in accordance with Federal requirements.

We recommend that the Indian Health Service work with Gallup Indian Medical Center and the Navajo Area Office to follow through on its plans for an agencywide process to facilitate compliance with the sight and supervision requirements for staff with pending background investigations, including documentation that supervision actually occurs.

We recommend that ASPR correct the one Push Package sample item in its Stockpile's inventory system and complete its annual warehouse inventory check by the established target date of September 2024.

We recommend that CVS Health refund to the Federal Government the $4,256,568 of estimated overpayments.

We recommend that CVS Health continue its examination of 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.

We recommend that Humana Health Plan, Inc. refund to the Federal Government the $6,777,385 of estimated overpayments.

We recommend that Humana Health Plan, 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.

CMS should implement additional safeguards to ensure that remote patient monitoring is used and billed appropriately in Medicare.

CMS should develop methods to identify what health data are being monitored.

CMS shoild identify and monitor companies that bill for remote patient monitoring.

CMS should geographically target efforts to increase the number of MOUD providers that treat Medicare enrollees in high-need counties.

CMS should work with SAMHSA to develop and maintain a list of active office-based buprenorphine providers.

CMS should pursue further actions to help States share knowledge with eachother and coordinate internally regarding strategies to ensure needed care for Medicaid enrollees with HIV.

We recommend that Novitas develop and deliver education to auditors and supervisors regarding applicable criteria and review requirements.

ACF should monitor whether States are conducting credit checks of all three CRAs for children aged 14 or older who are in foster care, as required.

ACF should seek to partner with other government agencies to develop strategies to address issues that States experienced working with CRAs.

We recommend the Massachusetts Executive Office of Health & Human Services follow up with the OTP providers to correct the three services that were not supported by the medical records.

We recommend that the South Carolina Department of Health and Human Services invoice for and collect manufacturers' rebates totaling $12,204,259 (Federal share) for single-source and top-20 multiple-source physician-administered drugs and refund the Federal share of rebates collected.

We recommend that the South Carolina Department of Health and Human Services ensure that all physician-administered drugs eligible for rebates after our audit period are processed for rebates.

We recommend that the Utah Department of Health and Human Services redetermine Medicaid eligibility for the six sampled enrollees whom we have identified as having had incorrectly completed eligibility determinations.

We recommend that the Utah Department of Health and Human Services identify and correct the eREP data limitations, which in some cases prevented proper reporting classification.

We recommend that the New Mexico Human Services Department work with the MCOs todevelop procedures to monitor PCS provider compliance with attendant qualifications, including those related to criminal background checks, abuse registry checks, TB tests, initial written competency tests, annual training, and CPR and first aid certifications; educate providers more frequently through methods such as guidance letters or webinars to increase PCS providers' understanding of attendant qualification requirements; and take corrective action against providers that do not ensure that attendants comply with qualification requirements, which could include removing providers that repeatedly fail to comply with the State's PCS program.

We recommend that the Kansas Department of Health and Education improve its electronic visit verification system by developing and implementing procedures to verify that in-home PCS claims are recorded and verified in its EVV system, and implementing edits to verify that tasks recorded on in-home PCS claims match allowable tasks approved in the PCSP.    

We recommend that the Kansas Department of Health and Education verify that providers are complying with the State agency's established policies and procedures to maintain documentation showing that service workers are registered, screened, and employable pursuant to background check requirements.

We recommend that the Centers for Medicare & Medicaid Services instruct the SSAs to follow up with the 24 nursing homes that may not have complied with Federal requirements to verify that they have taken corrective actions.

We recommend that the Illinois Department of Healthcare and Family Services remediate the four security control findings identified by OIG.

We recommend that the Illinois Department of Healthcare and Family Services enhance its testing procedures to include performing more robust technical testing of web-facing systems and emulation of an adversary's tactics and techniques on a defined reoccurring basis, in order to better assess the effectiveness of NIST SP 800-53 controls.