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 661–680 of 1,352 reports, containing 4,352 recommendations
Sorted by latest release date
-
North Carolina Made Capitation Payments to Managed Care Entities After Beneficiaries' Deaths
20-A-04-173.01We recommended that the North Carolina Department of Health and Human Services, Division of Health Benefits refund $1,948,657 (Federal share) to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $1,948,657
- Last Update Received
- -
- Closed Date
- 07/01/2021
- Legislative Related
- No
20-A-04-173.02We recommended that the North Carolina Department of Health and Human Services, Division of Health Benefits identify capitation payments made to managed care entities on behalf of deceased beneficiaries before and after our audit period and refund the Federal share of amounts recovered.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/01/2021
- Legislative Related
- No
20-A-04-173.03We recommended that the North Carolina Department of Health and Human Services, Division of Health Benefits improve the accuracy of NC FAST date of death information and apply MMIS edits as necessary to identify all deceased beneficiaries, prevent all capitation payments for monthly coverage after death, and recover such unallowable payments.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/01/2021
- Legislative Related
- No
-
States Continued To Fall Short in Meeting Required Timeframes for Investigating Nursing Home Complaints: 2016-2018
20-E-01-043.01CMS should ensure that all States receive training on CMS's updated triage guidance.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/14/2024
- Legislative Related
- No
20-E-01-043.02CMS should identify new approaches to address those States that are consistently failing to meet the required timeframes for investigating the most serious nursing home complaints.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/17/2024
- Legislative Related
- No
-
CMS's Monitoring Activities for Ensuring That Medicare Accountable Care Organizations Report Complete and Accurate Data on Quality Measures Were Generally Effective, but There Were Weaknesses That Could Be Improved
20-A-09-171.01To improve its monitoring activities for ensuring that ACOs report complete and accurate data on quality measures, we recommend that the Centers for Medicare & Medicaid Services update the Statement of Work to require its contractor to verify that survey vendors have corrected identified issues that directly relate to the collection or reporting of data.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/02/2021
- Legislative Related
- No
20-A-09-171.02To improve its monitoring activities for ensuring that ACOs report complete and accurate data on quality measures, we recommend that the Centers for Medicare & Medicaid Services update the Statement of Work to require its contractor to confirm that all implemented changes to address the identified issues are included in QAPs before they are approved.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/02/2021
- Legislative Related
- No
20-A-09-171.03To improve its monitoring activities for ensuring that ACOs report complete and accurate data on quality measures, we recommend that the Centers for Medicare & Medicaid Services update the Statement of Work to require its contractor to review the translated survey templates, mail survey packages, and telephone survey scripts to ensure that they are consistent with the English versions.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/02/2021
- Legislative Related
- No
-
Oregon's Oversight Did Not Ensure That Four Coordinated-Care Organizations Complied With Selected Medicaid Requirements Related to Access to Care and Quality of Care
20-A-09-172.01We recommend that the Oregon Health Authority provide additional guidance to CCOs on the processes for provider credentialing and for beneficiary grievances and appeals.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/05/2021
- Legislative Related
- No
20-A-09-172.02We recommend that the Oregon Health Authority provide additional guidance to CCOs on monitoring subcontractors.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/05/2021
- Legislative Related
- No
20-A-09-172.03We recommend that the Oregon Health Authority take actions to ensure that CCOs do not subcontract the adjudication of final appeals.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/05/2021
- Legislative Related
- No
20-A-09-172.04We recommend that the Oregon Health Authority take actions to ensure that the data that CCOs submit on grievances and appeals in the grievance workbooks are accurate and complete.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/05/2021
- Legislative Related
- No
-
Arkansas Medicaid Fraud Control Unit: 2019 Onsite Inspection
20-E-12-042.01Strengthen the Unit's fiscal controls by taking the following action: (1) Refund the Federal grant $6,774 in the unallowable and unsupported costs, ensure that future costs are coded accurately, and maintain supporting documentation for future costs on the Federal grant.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- $6,774
- Last Update Received
- -
- Closed Date
- 04/22/2021
- Legislative Related
- No
20-E-12-042.02Strengthen the Unit's fiscal controls by taking the following action: (2) Take steps to ensure that the Unit submits all required financial reports on time.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/22/2021
- Legislative Related
- No
20-E-12-042.03Strengthen the Unit's fiscal controls by taking the following action: (3) Ensure that all Unit laptops continue to be encrypted to protect the electronic information under the Unit's control.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/22/2021
- Legislative Related
- No
20-E-12-042.04Strengthen the Unit's fiscal controls by taking the following actions: (4) Establish policies and procedures to properly apply its approved indirect cost rate in calculating its indirect costs for Federal reimbursement.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/22/2021
- Legislative Related
- No
20-E-12-042.05Take steps to improve the Unit's communication and seek more opportunities to investigate joint cases with OIG's Office of Investigations.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/22/2021
- Legislative Related
- No
20-E-12-042.06Take steps to ensure that the Unit staff reports all convictions and adverse actions to Federal partners within the appropriate timeframes.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/22/2021
- Legislative Related
- No
-
CMS Should Pursue Strategies To Increase the Number of At Risk Beneficiaries Acquiring Naloxone Through Medicaid
20-E-BL-041.01CMS should pursue strategies to increase the number of at-risk beneficiaries acquiring community-use versions of naloxone through Medicaid.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/22/2021
- Legislative Related
- No
-
Connecticut Did Not Meet Federal and State Requirements for Claiming Medicaid School-Based Child Health Services for Hartford Public Schools
20-A-01-170.01We recommend that the Connecticut Department of Social Services refund $761,179 to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $761,179
- Last Update Received
- -
- Closed Date
- 07/31/2021
- Legislative Related
- No
20-A-01-170.02We recommend that the Connecticut Department of Social Services work with CMS to review Medicaid payments made to HPS after our audit period and refund any overpayments.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/10/2025
- Legislative Related
- No
20-A-01-170.03We recommend that the Connecticut Department of Social Services strengthen its oversight of the SBCH program by working with DAS to develop a detailed review process for claims submitted by the LEAs to ensure that all claims meet Federal and State requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/03/2023
- Legislative Related
- No
-
North Carolina Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness
20-A-04-168.01We recommend that the North Carolina Department of Health and Human Services follow up with the 18 nursing homes to verify 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
- 08/25/2021
- Legislative Related
- No
20-A-04-168.02We recommend that the North Carolina Department of Health and Human Services work with CMS to develop life safety training for nursing home staff.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/25/2021
- Legislative Related
- No
20-A-04-168.03We recommend that the North Carolina Department of Health and Human Service conduct more frequent site 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
- 08/26/2021
- Legislative Related
- No
20-A-04-168.04We recommend that the North Carolina Department of Health and Human Service work with LEM agencies to develop a process to monitor the submission of emergency plans.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/25/2021
- Legislative Related
- No
20-A-04-168.05We recommend that the North Carolina Department of Health and Human Services increase collaboration with LEM agencies to: clarify roles and responsibilities; make them aware of pending, or newly licensed, nursing homes in their counties; provide LEM agencies with survey results, to the extent possible, from individual nursing homes to identify specific vulnerabilities.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/25/2021
- Legislative Related
- No
20-A-04-168.06We recommend that the North Carolina Department of Health and Human Services increase collaboration with RHCs and communication with nursing home administrators to ensure nursing homes are aware of resources available to them.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/25/2021
- Legislative Related
- No
-
Vermont Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs
20-A-07-169.01We recommend that the Vermont Agency of Human Services, Department of Vermont Health Access refund to the Federal Government $357,706 (Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $357,706
- Last Update Received
- -
- Closed Date
- 08/23/2024
- Legislative Related
- No
20-A-07-169.02We recommend that the Vermont Agency of Human Services, Department of Vermont Health Access refund to the Federal Government $47,389 (Federal share) for claims for top-20 multiple-source physician-administered drugs that were ineligible for Federal reimbursement.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $47,389
- Last Update Received
- -
- Closed Date
- 08/23/2024
- Legislative Related
- No
20-A-07-169.03We recommend that the Vermont Agency of Human Services, Department of Vermont Health Access work with CMS to determine the unallowable portion of $78,363 (Federal share) for other claims for multiple-source physician-administered drugs that may have been ineligible for Federal reimbursement, refund that amount, and consider invoicing drug manufacturers for rebates for these drugs if CMS determines that the drug claims are allowable.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/23/2024
- Legislative Related
- No
20-A-07-169.04We recommend that the Vermont Agency of Human Services, Department of Vermont Health Access work with CMS to determine and refund the unallowable portion of Federal reimbursement for physician-administered drugs that were not invoiced for rebates after December 31, 2017.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/09/2024
- Legislative Related
- No
20-A-07-169.05We recommend that the Vermont Agency of Human Services, Department of Vermont Health Access strengthen its internal controls to ensure that all physician-administered drugs eligible for rebates are invoiced.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/09/2024
- Legislative Related
- No
-
Illinois Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness
20-A-05-167.01We recommend that the Illinois Department of Public Health follow up with the 15 nursing homes to verify 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
- 01/14/2021
- Legislative Related
- No
20-A-05-167.02We recommend that the Illinois Department of Public Health conduct more thorough emergency preparedness reviews in accordance with Appendix Z for the safety and protection of nursing home residents and staff.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/14/2021
- Legislative Related
- No
20-A-05-167.03We recommend that the Illinois Department of Public Health work with CMS to develop emergency preparedness training and expand life safety training sessions to accommodate all nursing home administrators.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/14/2021
- Legislative Related
- No
20-A-05-167.04We recommend that the Illinois Dept of Public Health consider increasing staffing standards and caseload thresholds for State surveyors.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/14/2021
- Legislative Related
- No
20-A-05-167.05We recommend that the Illinois Department of Public Health consider modifying its survey procedures to check for carbon monoxide alarms required by Illinois law.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/14/2021
- Legislative Related
- No
-
Medicare-Allowed Charges for Noninvasive Ventilators Are Substantially Higher Than Payment Rates of Select Non-Medicare Payers
20-A-05-165.01We recommend that the Centers for Medicare & Medicaid Services review the Medicare-allowed charges for noninvasive ventilators HCPCS code E0466, for which Medicare and beneficiaries could have potentially saved an estimated $86,579,173 in CYs 2016 through 2018, and add noninvasive ventilators HCPCS code E0466 to the competitive bidding program as soon as practicable.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $86,579,173
- Last Update Received
- -
- Closed Date
- 03/17/2021
- Legislative Related
- No
-
Southwest Key Programs Failed To Protect Federal Funds Intended for the Care and Placement of Unaccompanied Alien Children
20-A-06-163.01We recommend that Southwest Key Programs refund to the Federal Government $1,354,429 in unallowable executive compensation.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- $1,354,429
- Last Update Received
- -
- Closed Date
- 04/07/2023
- Legislative Related
- No
20-A-06-163.02We recommend that Southwest Key Programs review UAC facility leases, and, for those that qualify as capital or related-party leases, ensure that rental costs claimed comply with Federal regulations.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/07/2023
- Legislative Related
- No
20-A-06-163.03We recommend that Southwest Key Programs implement procedures to review leases and ensure that any ancillary costs claimed comply with Federal regulations.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 07/31/2023
- Next Update Expected
- 01/31/2024
- Legislative Related
- No
20-A-06-163.04We recommend that Southwest Key Programs maintain supporting documentation that shows employees who receive a bonus qualify for the bonus and that bonuses paid comply with Southwest Key's bonus policy and Federal regulations.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/06/2023
- Next Update Expected
- 10/07/2023
- Legislative Related
- No
20-A-06-163.05We recommend that Southwest Key Programs revise the bonus policy to establish a maximum percentage when calculating bonuses paid with Federal funds and to ensure that all bonuses are reasonable.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 03/14/2023
- Next Update Expected
- 09/28/2023
- Legislative Related
- No
20-A-06-163.06We recommend that Southwest Key Programs ensure that no Federal funding, direct or indirect, is used for future compensation that exceeds the statutorily allowed rate for executive compensation.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 07/31/2023
- Next Update Expected
- 01/31/2024
- Legislative Related
- No
20-A-06-163.07We recommend that Southwest Key Programs develop a quality control procedure to ensure that costs claimed are accurate, adequately supported, and benefit the award.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 07/31/2023
- Next Update Expected
- 01/31/2024
- Legislative Related
- No
20-A-06-163.08We recommend that Southwest Key Programs maintain documentation to support the FFRs.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/28/2023
- Legislative Related
- No
20-A-06-163.09We recommend that Southwest Key Programs strengthen policies and procedures and develop a quality control measure to ensure that the fixed assets are recorded timely and in the correct period.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/28/2023
- Legislative Related
- No
20-A-06-163.10We recommend that the Office of Refugee Resettlement review Southwest Key's remaining UAC facility leases to determine whether they qualify as capital leases, and recover any unallowable costs.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 02/13/2024
- Next Update Expected
- 08/20/2024
- Legislative Related
- No
20-A-06-163.11We recommend that the Office of Refugee Resettlement review the capital leases identified in our audit to determine the amount of unallowable costs associated with the leases since their inception and after our review, and recover any unallowable costs.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 02/13/2024
- Next Update Expected
- 08/20/2024
- Legislative Related
- No
20-A-06-163.12We recommend that the Office of Refugee Resettlement review UAC facility leases since their inception and after our review to ensure the leases meet Federal requirements and include only allowable costs, and recover any unallowable costs.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 02/13/2024
- Next Update Expected
- 08/20/2024
- Legislative Related
- No
20-A-06-163.13We recommend that the Office of Refugee Resettlement ensure that Southwest Key adheres to the statutorily allowed rate for executive compensation.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/20/2024
- Legislative Related
- No
20-A-06-163.14We recommend that the Office of Refugee Resettlement review Southwest Key's bonus policy to ensure that it meets Federal requirements.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 02/13/2024
- Next Update Expected
- 08/20/2024
- Legislative Related
- No
20-A-06-163.15We recommend that Southwest Key Programs refund to the Federal Government $10,529,446 in unallowable direct costs and $1,246,973 in associated indirect costs.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- $11,776,419
- Last Update Received
- -
- Closed Date
- 04/07/2023
- Legislative Related
- No
20-A-06-163.16We recommend that the Office of Refugee Resettlement provide guidance to Southwest Key related to allowable renovation costs and when prior approval for renovations is required.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/20/2024
- Legislative Related
- No
-
Incorrect Acute Stroke Diagnosis Codes Submitted by Traditional Medicare Providers Resulted in Millions of Dollars in Increased Payments to Medicare Advantage Organizations
20-A-07-164.01We recommend that the Centers for Medicare & Medicaid Services educate physicians on how to correctly submit acute stroke diagnosis codes on physicians' claims and on how these diagnosis codes may impact the MA program.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/19/2021
- Legislative Related
- No
20-A-07-164.02We recommend that the Centers for Medicare & Medicaid Services develop and implement policies and procedures to identify beneficiaries transferring from traditional Medicare to MA, and evaluate whether the acute stroke diagnosis codes submitted under traditional Medicare comply with Federal requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $14,417,533
- Last Update Received
- 03/19/2025
- Next Update Expected
- 09/19/2025
- Legislative Related
- No
-
Noridian Healthcare Solutions, LLC, Claimed Some Unallowable Medicare Nonqualified Plans Costs Through Its Incurred Cost Proposals
20-A-07-166.01We recommend that Noridian Healthcare Solutions LLC work with CMS to ensure that its final settlement of contract costs reflects a decrease in Medicare nonqualified cost of $1,348,960 for CYs 2014 through 2016.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $1,348,960
- Last Update Received
- -
- Closed Date
- 03/05/2021
- Legislative Related
- No
-
Maine Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs
20-A-07-162.01We recommend that the Maine Department of Health and Human Services refund to the Federal Government $4,004,984 (Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $4,004,984
- Last Update Received
- -
- Closed Date
- 03/10/2023
- Legislative Related
- No
20-A-07-162.02We recommend that the Maine Department of Health and Human Services refund to the Federal Government $276,229 (Federal share) for claims for top-20 multiple-source physician-administered drugs that were ineligible for Federal reimbursement.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $276,229
- Last Update Received
- -
- Closed Date
- 03/10/2023
- Legislative Related
- No
20-A-07-162.03We recommend that the Maine Department of Health and Human Services work with CMS to determine the unallowable portion of $605,768 (Federal share) for other claims for multiple-source physician-administered drugs that may have been ineligible for Federal reimbursement, refund that amount, and consider invoicing drug manufacturers for rebates for these drugs if CMS determines that the drug claims are allowable.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/16/2020
- Legislative Related
- No
20-A-07-162.04We recommend that the Maine Department of Health and Human Services consider invoicing drug manufacturers for rebates totaling $10.8 million (Federal share) for claims for physician-administered drugs dispensed at non-Critical Access Hospitals.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $10,801,067
- Last Update Received
- -
- Closed Date
- 03/10/2023
- Legislative Related
- No
20-A-07-162.05We recommend that the Maine Department of Health and Human Services strengthen its internal controls to ensure that all physician-administered drugs eligible for rebates are invoiced.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/16/2020
- Legislative Related
- No
-
Some Manufacturers Reported Inaccurate Drug Product Data to CMS
20-E-03-040.01CMS should work with the manufacturers associated with errors to correct and resubmit accurate product data.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/01/2024
- Legislative Related
- No
-
Medicare Home Health Agency Provider Compliance Audit: Mercy Health Visiting Nurse Services
20-A-05-156.01We recommend that Mercy Health Visiting Nurse Services refund to the Medicare program the portion of the estimated $1,074,136 in overpayments for claims incorrectly billed that are within the 4-year reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $1,074,136
- Last Update Received
- -
- Closed Date
- 12/21/2022
- Legislative Related
- No
20-A-05-156.02We recommend that Mercy Health Visiting Nurse 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
- $4,919
- Last Update Received
- -
- Closed Date
- 05/18/2021
- Legislative Related
- No
20-A-05-156.03We recommend Mercy Health Visiting Nurse 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
- 02/03/2021
- Legislative Related
- No
-
Group Health Incorporated Overstated Its EmblemHealth Services Company, LLC, Employees' Retirement Plan Medicare Segment Pension Assets and Understated Medicare's Share of the Medicare Segment Pension Assets as of December 31, 2015
20-A-07-157.01We recommend that GHI decrease the EHS Retirement Plan Medicare segment pension assets by $351,803 and recognize $5,399,565as the EHS Retirement Plan Medicare segment assets as of December 31, 2015.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/05/2021
- Legislative Related
- No
20-A-07-157.02We recommend that GHI increase Medicare's share of EHS Retirement Plan Medicare segment excess pension assets as of December 31, 2015 by $1,83,427 and recognize $404,616 as Medicare's share of the pension assets as a result of the benefit curtailment.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $1,183,427
- Last Update Received
- -
- Closed Date
- 03/05/2021
- Legislative Related
- No
-
Group Health Incorporated Overstated Its Local 153 Pension Plan Medicare Segment Assets and Understated Medicare's Share of the Medicare Segment Pension Assets as of August 31, 2016
20-A-07-158.01We recommend that GHI decrease the Local 153 Plan Medicare segment pension assets by $4,898,757 and recognize $36,888,234 as the Local 153 Plan Medicare segment pension assets as of August 31, 2016.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/05/2021
- Legislative Related
- No
20-A-07-158.02We recommend that GHI increase Medicare's share of the local 153 Plan Medicare segment excess pension assets as of August 31, 2016 by $6,987,526 and recognize $855,827 as Medicare's share of the pension assets as a result of the benefit curtailment.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $6,987,526
- Last Update Received
- -
- Closed Date
- 03/05/2021
- Legislative Related
- No
-
Group Health Incorporated Did Not Claim Some Allowable Medicare Pension Costs for Calendar Years 2009 Through 2016
20-A-07-159.01We recommend that GHI work with CMS to ensure that its final settlement of contract costs reflects an increase in Medicare pension costs of $1,101,642 for CYs 2009 through 2016.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/03/2022
- Legislative Related
- No