Recommendations Tracker

We recommend that University of Michigan Health System based upon the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.

We recommend that the New Mexico Human Services Department work with CMS to determine whether the 25,341 claim lines related to non-top-20 multiple-source physician-administered drugs that we calculated to be at least $226,644 ($164,793 Federal share) were eligible for rebates and, if so, determine the rebates due and, upon receipt of the rebates, refund the Federal share of the rebates collected.

We recommend that the New Mexico Human Services Department strengthen internal controls to ensure that all eligible physician-administered drugs are billed for rebate.

We recommend that Caretenders strengthen its procedures to ensure that the homebound status of Medicare beneficiaries is verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented; beneficiaries are receiving only reasonable and necessary skilled services; and HIPPS codes are billed correctly.

We recommend Gateway update and follow its procedures to ensure compliance with all Federal requirements and the accuracy of cost information, including cost proposals, submitted to ACF. Gateway did not comply with Federal requirements related to new construction and major renovations of its Head Start facilities.

We recommend that the Administration for Children and Families ensure that Gateway complies with Federal requirements and verify information submitted by Gateway to support Gateway's grant award applications, including requesting Gateway to obtain independent analyses of cost comparisons for Head Start facility construction and major renovations.

We recommend that BCBS of SC develop and implement policies and procedures to ensure that going forward, it calculates Medicare segment pension assets in accordance with Federal requirements.

We recommend that the Centers for Medicare & Medicaid Services direct the Medicare contractors to recover the $291,813 from physicians for instances in which the same physicians reported more than one CPT code and received MCPs for monthly ESRD-related services provided to the same beneficiary for the same month of service (for claims that are within the 4-year reopening period).

We recommend that the Centers for Medicare & Medicaid Services direct the Medicare contractors to review the 1,598 claims totaling $289,169 in MCPs for potentially duplicate claims and $74,563 in associated beneficiary cost sharing (deductible and coinsurance amounts) and determine which of the claims should have been denied as a duplicate claim for ESRD-related services and recover the portion of any MCPs from the physicians for claims for duplicate services (that are within the 4-year reopening period); and instruct the physicians to refund beneficiaries the portion of the deductible and coinsurance amounts that may have been incorrectly collected from beneficiaries or from someone on their behalf.

We recommend that the Centers for Medicare & Medicaid Services implement improved claims processing controls, including improved system edits, to prevent and detect overpayments of claims for duplicate services.

We recommend that Anthem Community Insurance Company, 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.

We recommended that Sleep Management based upon the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.

We recommend that the New York State Office of Temporary and Disability Assistance improve its oversight of the TANF program by providing additional guidance and training to ensure that its local districts accurately report expenditures and maintain adequate documentation to support TANF and MOE expenditures reported.

We recommend that Franciscan based upon the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.

We recommend that Alive Hospice, Inc. based upon the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.

We recommend that Ambercare Hospice, Inc. based upon the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.

We recommend that the New York State Department of Health identify and recover improper managed care payments made to the same MCO on behalf of beneficiaries with more than one Medicaid ID number prior to and after our audit period, and repay the Federal share of the amounts recovered.

We recommend that the Centers for Medicare & Medicaid Services direct the Medicare contractors to educate providers on the billing of direct LDL tests in addition to lipid panels (e.g., by providing guidance about the requirements for separately billing direct LDL tests).

We recommend that Suncoast Hospice based upon the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.

We recommend that the Minnesota Department of Human Services ensure that county caseworkers follow procedures to timely review and terminate eligibility for beneficiaries who were identified as concurrently eligible in another State.

We recommend that Louisiana perform timely analytical procedures, such as data matches, on Medicaid claims data to identify unreported critical incidents and investigate as needed.

We recommend that Louisiana track direct service providers' and support coordinators' compliance with the reporting timeframes outlined in the waiver.

We recommend that Virtua Our Lady of Lourdes Hospital based on the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.