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 December 17, 2025
1,189
Unimplemented
recommendations
3,163
Implemented and Closed
recommendations since FY 2017
Views
OIG Recommendations Grouped by Report
Showing 601–620 of 1,352 reports, containing 4,352 recommendations
Sorted by latest release date
-
CMS Authorized Hundreds of Millions of Dollars in Advanced Premium Tax Credits on Behalf of Enrollees Who Did Not Make Their Required Premium Payments
21-A-02-066.01We recommend that the Centers for Medicare & Medicaid Services work with Treasury and QHP issuers to recover the $43,455 in improper APTCs identified in our sample, or take other remedial action.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/09/2023
- Legislative Related
- No
21-A-02-066.02We recommend that the Centers for Medicare & Medicaid Services work with Treasury and QHP issuers to recover the remaining improper APTCs, which we estimate to be $950 million, or take other remedial action for policies for which the payments were not allowable.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/09/2023
- Legislative Related
- No
21-A-02-066.03We recommend that the Centers for Medicare & Medicaid Services develop a process for qualified health plan issuers to provide (a) information related to individuals' premium payments paid during the benefit year, and (b) enrollees' policy termination information so that enrollment data provided to the Internal Revenue Service is accurate.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/02/2025
- Legislative Related
- No
-
ACF Cannot Ensure That All Child Victims of Abuse and Neglect Have Court Representation
21-E-12-015.01ACF should conduct oversight activities to identify States that may not appoint a GAL to every child victim who undergoes a judicial proceeding, seeking statutory authority as necessary.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 11/14/2023
- Next Update Expected
- 07/01/2024
- Legislative Related
- Yes
21-E-12-015.02ACF should proactively provide technical assistance to States that face challenges in appointing a GAL for every child victim.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 11/14/2023
- Next Update Expected
- 01/16/2025
- Legislative Related
- No
21-E-12-015.03ACF should proactively identify and address obstacles that States face in reporting complete and accurate GAL data.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 11/14/2023
- Next Update Expected
- 01/16/2025
- Legislative Related
- No
-
Medicare Home Health Agency Provider Compliance Audit: Brookdale Home Health, LLC
21-A-04-065.01We recommend that Brookdale Home Health, LLC refund to the Medicare program the portion of the estimated $3,286,869 overpayment for claims incorrectly billed that are within the 4-year reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $3,286,869
- Last Update Received
- -
- Closed Date
- 06/30/2021
- Legislative Related
- No
21-A-04-065.02We recommend that Brookdale Home Health, LLC, based on the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule 16 and identify any of those returned overpayments as having been made in accordance with this recommendation.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $44,340
- Last Update Received
- -
- Closed Date
- 04/12/2022
- Legislative Related
- No
21-A-04-065.03We recommend that Brookdale Home Health, LLC strengthen its procedures to ensure that the homebound statuses of Medicare beneficiaries are verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented and beneficiaries are receiving only reasonable and necessary skilled services.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/29/2021
- Legislative Related
- No
-
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Blue Cross Blue Shield of Michigan (Contract H9572) Submitted to CMS
21-A-02-064.01We recommend that Blue Cross Blue Shield Michigan refund to the Federal Government the $14,534,375 of net overpayments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $14,534,375
- Last Update Received
- 09/11/2025
- Next Update Expected
- 03/11/2026
- Legislative Related
- No
21-A-02-064.02We recommend BCBSM 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
- Concur
- Potential Savings
- -
- Last Update Received
- 09/11/2025
- Next Update Expected
- 03/11/2026
- Legislative Related
- No
21-A-02-064.03We recommend that BCBSM examine its existing compliance procedures to identify areas where improvements can be made to ensure 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
- Concur
- Potential Savings
- -
- Last Update Received
- 09/11/2025
- Next Update Expected
- 03/11/2026
- Legislative Related
- No
-
Medicare Hospice Provider Compliance Audit: Tidewell Hospice, Inc.
21-A-02-063.01We recommend that Tidewell Hospice, Inc. refund to the Federal Government the portion of the estimated $8,305,371 for hospice services that did not comply with Medicare requirements and that are within the 4-year claims reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $8,305,371
- Last Update Received
- -
- Closed Date
- 06/23/2021
- Legislative Related
- No
21-A-02-063.02We recommend that Tidewell 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.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $186,271
- Last Update Received
- -
- Closed Date
- 04/06/2022
- Legislative Related
- No
21-A-02-063.03We recommend that Tidewell strengthen its policies and procedures to ensure that hospice services comply with Medicare requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/11/2024
- Legislative Related
- No
-
Trend Toward More Expensive Inpatient Hospital Stays in Medicare Emerged Before COVID-19 and Warrants Further Scrutiny
21-E-02-014.01CMS should conduct targeted reviews of MS-DRGs and stays that are vulnerable to upcoding, as well as the hospitals that frequently bill for them.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 07/19/2022
- Next Update Expected
- 08/08/2023
- Legislative Related
- No
-
Virginia's Monitoring Did Not Ensure Child Care Provider Compliance With State Criminal Background Check Requirements at 8 of 30 Providers Reviewed
21-A-03-061.01We recommend that the Virginia Department of Social Services conduct all required criminal background checks for the 15 individuals in our sample who did not have the required checks at the time of our review.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/29/2022
- Legislative Related
- No
21-A-03-061.02We recommend that the Virginia Department of Social Services revise State guidelines to specify that inspectors should use verified information, such as payroll data, from each child day center to determine which employees' criminal background checks must be reviewed.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/29/2022
- Legislative Related
- No
21-A-03-061.03We recommend that the Virginia Department of Social Services revise State guidelines to increase the number of current employees that inspectors review at all child day centers to ensure provider compliance with criminal background check requirements.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/29/2022
- Legislative Related
- No
21-A-03-061.04We recommend that the Virginia Department of Social Services provide periodic training to providers to ensure they request required background checks.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/29/2022
- Legislative Related
- No
-
Noridian Healthcare Solutions, LLC, Made Improper Medicare Payments of $4 Million to Physicians in Jurisdiction E for Spinal Facet-Joint Injections
21-A-09-062.01We recommend that Noridian Healthcare Solutions, LLC recover $12,546 in improper payments made to physicians.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $12,546
- Last Update Received
- -
- Closed Date
- 06/11/2021
- Legislative Related
- No
21-A-09-062.02We recommend that Noridian Healthcare Solutions, LLC based upon the results of this audit, notify appropriate physicians (i.e., those for whom Noridian determines this audit constitutes credible information of potential overpayments) so that the physicians can 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.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/11/2021
- Legislative Related
- No
21-A-09-062.03We recommend that Noridian Healthcare Solutions, LLC provide annual training to physicians and their billing staff in Jurisdiction E specific to Medicare requirements for billing of facet-joint injections, which could have saved an estimated $4,155,889 for our audit period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $4,155,889
- Last Update Received
- -
- Closed Date
- 06/11/2021
- Legislative Related
- No
-
Although the Bemidji Area Office Had Adequate Procedures To Disburse Indian Health Service Funds, It Needs To Strengthen Its Procedures for Monitoring the Use of the Funds
21-A-05-060.01We recommend that BAO establish procedures to reconcile IHS funds recorded in the UFMS on a regular schedule with amounts reported in supporting documents, such as worksheets and funding agreements.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/05/2022
- Legislative Related
- No
21-A-05-060.02We recommend that BAO establish procedures to monitor and evaluate IHS Direct programs' use of no-year Health Services funds carried forward by appropriation year and budget activity program.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/02/2024
- Legislative Related
- No
21-A-05-060.03We recommend that BAO establish procedures to evaluate IHS Direct programs' use of current no-year Health Services funds.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/05/2022
- Legislative Related
- No
-
New York Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities
21-A-02-058.01We recommend that the New York State Department of Health work with the Office for People With Developmental Disabilities and the Justice Center to reinforce guidance to the provider community on requirements related to the timing and method of initially reporting incidents; the timely completion of incident investigations; and the need to document justifications for investigative delays.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/28/2021
- Legislative Related
- No
21-A-02-058.02We recommend that the New York State Department of Health work with the Office for People With Developmental Disabilities and the Justice Center to issue guidance and/or provide training to the provider community on the importance of identifying the root causes of incidents.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/28/2021
- Legislative Related
- No
21-A-02-058.03We recommend that the New York State Department of Health work with the Office for People With Developmental Disabilities and the Justice Center to issue guidance and/or provide training to the provider community on the importance of identifying trends in incidents.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/28/2021
- Legislative Related
- No
21-A-02-058.04We recommend that the New York State Department of Health work with the Office for People With Developmental Disabilities and the Justice Center to review the three internal occurrence investigations identified in our report to determine whether the providers complied with applicable requirements, and make any necessary changes to the incident classifications in accordance with Part 624.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/28/2021
- Legislative Related
- No
-
Iowa Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness
21-A-07-059.01We recommend that the Iowa Department of Human Services, Iowa Medicaid Enterprise follow up with the 20 nursing homes to ensure that corrective actions have been taken regarding the life safety and emergency preparedness deficiencies identified in this report.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/29/2021
- Legislative Related
- No
21-A-07-059.02We recommend that the Iowa Department of Human Services, Iowa Medicaid Enterprise work with CMS to develop standardized life safety training for nursing home staff; conduct more frequent surveys at nursing homes that have a history of multiple high-risk deficiencies; and require nursing homes and inspection contractors to tag systems that are critical to the health and safety of nursing home residents when they have found that these systems may not work as required when needed and notify the State agency.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/29/2021
- Legislative Related
- No
21-A-07-059.03We recommend that the Iowa Department of Human Services, Iowa Medicaid Enterprise conduct more frequent surveys at nursing homes that have a history of multiple high-risk deficiencies.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/29/2021
- Legislative Related
- No
21-A-07-059.04We recommend that the Iowa Department of Human Services, Iowa Medicaid Enterprise require nursing homes and inspection contractors to tag systems that are critical to the health and safety of nursing home residents when they have found that these systems may not work as required when needed and notify the State agency.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/29/2021
- Legislative Related
- No
-
Illinois Made Capitation Payments to Managed Care Organizations for Medicaid Beneficiaries With Concurrent Eligibility in Another State
21-A-05-056.01We recommend that the Illinois Department of Healthcare and Family Services develop or enhance current procedures to identify beneficiaries with concurrent eligibility in another State, which could have saved the State agency an estimated $3,790,896 ($2,094,545 Federal share) in capitation payments for the month of August 2018.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $2,094,545
- Last Update Received
- -
- Closed Date
- 05/12/2021
- Legislative Related
- No
21-A-05-056.02We recommend that the Illinois Department of Healthcare and Family Services ensure that procedures are in place for caseworkers to timely review and terminate eligibility for beneficiaries who were identified as concurrently eligible in another State.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/07/2021
- Legislative Related
- No
-
Louisiana Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries
21-A-06-055.01We recommend that the Louisiana Department of Health promptly provide notice and cancel the eligibility of beneficiaries identified with income over the allowable limit.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/03/2022
- Legislative Related
- No
21-A-06-055.02We recommend that Louisiana's Department of Health educate State analysts on established policies and procedures regarding requirements to promptly provide notice and cancel eligibility, verify income, and provide retroactive eligibility.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/03/2022
- Legislative Related
- No
21-A-06-055.03We recommend that Louisiana's Department of Health redetermine, if necessary, the current Medicaid eligibility status of the sample beneficiaries for whom income or dependent verifications did not meet Federal and State requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/03/2022
- Legislative Related
- No
-
Massachusetts Made at Least $14 Million in Improper Medicaid Payments for the Nonemergency Medical Transportation Program
21-A-01-053.01We recommend that the Massachusetts Executive Office of Health and Human Services refund to the Federal Government $7,071,365 in estimated overpayments for NEMT claim lines associated with NEMT services that did not comply with Federal and State requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $7,071,365
- Last Update Received
- -
- Closed Date
- 02/16/2022
- Legislative Related
- No
21-A-01-053.02We recommend that the Massachusetts Executive Office of Health and Human Services perform data matches to all medical claims billed on the day of the NEMT service to ensure NEMT lines of service are paid only when there is a corresponding qualifying medical service.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/16/2022
- Legislative Related
- No
21-A-01-053.03We recommend that the Massachusetts Executive Office of Health and Human Services work with its brokers to implement controls that ensure NEMT services are sufficiently supported by requiring brokers to verify that documentation contains all the necessary elements (in a legible manner) to support the NEMT service; evaluating whether GPS or other monitoring of drivers would be an effective control to verify whether transportation had occurred or was to the destination listed on the PT-1; and implementing controls that verify that the beneficiary was in the vehicle on the day of the billed NEMT service.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/16/2022
- Legislative Related
- No
21-A-01-053.04We recommend that the Massachusetts Executive Office of Health and Human Services work with its brokers to implement controls that ensure drivers and vehicles used to provide NEMT services can be directly and clearly traced to the associated driver qualifications and vehicle records.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/16/2022
- Legislative Related
- No
21-A-01-053.05We recommend that the Massachusetts Executive Office of Health and Human Services give brokers the authority to deny unusual transportation requests when medical services cannot be verified (e.g., medical appointment after business hours).- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/16/2022
- Legislative Related
- No
21-A-01-053.06We recommend that the Massachusetts Executive Office of Health and Human Services provide the brokers with standard language they can send to confirm medical appointments.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/16/2022
- Legislative Related
- No
-
California Claimed at Least $2 Million in Unallowable Medicaid Reimbursement for a Selected Provider's Opioid Treatment Program Services
21-A-09-054.01We recommend that the California Department of Health Care Services refund $2,416,900 to the Federal Government for unallowable OTP services furnished by the selected provider.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $2,416,900
- Last Update Received
- -
- Closed Date
- 05/05/2021
- Legislative Related
- No
21-A-09-054.02We recommend that the California Department of Health Care Services ensure that the selected provider complies with Federal and State requirements for providing and claiming reimbursement for OTP services.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/17/2023
- Legislative Related
- No
21-A-09-054.03We recommend that the California Department of Health Care Services verify that the selected provider implements corrective action plans that were approved by the State agency.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/14/2023
- Legislative Related
- No
21-A-09-054.04We recommend that the California Department of Health Care Services perform postpayment reviews to identify disallowances for OTP services that did not comply with State regulations and State plan requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/12/2023
- Legislative Related
- No
21-A-09-054.05We recommend that the California Department of Health Care Services work with the selected provider to improve the quality of care provided to beneficiaries by correcting deficiencies.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/22/2023
- Legislative Related
- No
-
Choctaw Nation of Oklahoma Made Progress Toward Meeting Program Goals During the First Year of Its Tribal Opioid Response Grant
21-A-07-052.01We recommend that the Choctaw Nation of Oklahoma refund unallowable costs of $2,405 to the TOR grant.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- $2,405
- Last Update Received
- -
- Closed Date
- 08/18/2021
- Legislative Related
- No
21-A-07-052.02We recommend that the Choctaw Nation of Oklahoma train staff to identify contract costs that are allowable under Federal regulations.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/19/2021
- Legislative Related
- No
21-A-07-052.03We recommend that the Choctaw Nation of Oklahoma strengthen policies and procedures by clarifying responsibilities between and within Tribal departments for the review and approval of costs submitted on contractor invoices.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/19/2021
- Legislative Related
- No
21-A-07-052.04We recommend that the Choctaw Nation of Oklahoma establish policies and procedures that give staff members from the finance and program departments access to contractual agreements so that they can determine which costs are allowable under both the contractual agreement and the Federal grant.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/22/2022
- Legislative Related
- No
-
CMS and Its Contractors Did Not Use Comprehensive Error Rate Testing Program Data To Identify and Focus on Error-Prone Providers
21-A-05-050.01We recommend that the Centers for Medicare & Medicaid Services review the list of 100 error-prone providers identified in this audit and take specific action as appropriate, such as prior authorization, prepayment reviews, and postpayment review.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 03/13/2025
- Next Update Expected
- 10/01/2025
- Legislative Related
- No
21-A-05-050.02We recommend that the Centers for Medicare & Medicaid Services use annual CERT data to identify individual providers that have an increased risk of receiving improper payments and apply additional program integrity tools to these providers.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 03/31/2025
- Next Update Expected
- 09/30/2025
- Legislative Related
- No
-
Medicare Home Health Agency Provider Compliance Audit: Southeastern Home Health Services
21-A-03-049.01We recommend that Southeastern Home Health Services, 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.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/24/2021
- Legislative Related
- No
21-A-03-049.02We recommend that Southeastern Home Health Services strengthen its procedures to ensure that the homebound statuses of Medicare beneficiaries are verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented, beneficiaries are receiving only reasonable and necessary skilled services, and the correct HIPPS payment codes are billed.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/24/2021
- Legislative Related
- No
-
States Could Do More to Oversee Spending and Contain Medicaid Costs for Specialty Drugs
21-E-03-009.01CMS should work with States to expand alternative reimbursement models to address the rising costs for drugs often categorized as specialty drugs.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/27/2022
- Legislative Related
- No
21-E-03-009.02CMS should provide States with acquisition cost data for a wider range of specialty drugs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 10/22/2024
- Next Update Expected
- 11/19/2025
- Legislative Related
- No
21-E-03-009.03CMS should collaborate with States to conduct greater oversight of Medicaid MCOs' management of specialty drugs; this oversight could include a review of contract language that allows States to obtain requested information on specialty drug categorizations, specialty drug reimbursement methodologies, and cost management strategies.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/19/2024
- Legislative Related
- No
-
Medicare Home Health Agency Provider Compliance Audit: Tender Touch Health Care Services
21-A-04-042.01We recommend that Tender Touch Health Care Services refund to the Medicare program the portion of the estimated $478,780 overpayment for claims incorrectly billed that are within the 4-year reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $478,780
- Last Update Received
- -
- Closed Date
- 04/23/2021
- Legislative Related
- No
21-A-04-042.02We recommend that Tender Touch Health Care Services 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.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/23/2021
- Legislative Related
- No
21-A-04-042.03We recommend that Tender Touch Health Care Services strengthen its procedures to ensure that the homebound statuses of Medicare beneficiaries are verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented and beneficiaries are receiving only reasonable and necessary skilled services.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/23/2021
- Legislative Related
- No