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 681–700 of 1,352 reports, containing 4,352 recommendations
Sorted by latest release date
-
Group Health Incorporated Overstated Its Allowable Medicare Supplemental Executive Retirement Plan Costs for Calendar Years 2009 Through 2016
20-A-07-160.01We recommend that GHI work with CMS to revise its ICPs for CYs 2009 through 2016 to reduce its claimed SERP costs by $586,734.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $586,734
- Last Update Received
- -
- Closed Date
- 03/05/2021
- Legislative Related
- No
-
Group Health Incorporated Claimed Some Unallowable Medicare Postretirement Benefit Costs for Calendar Years 2009 Through 2016
20-A-07-161.01We recommend that GHI work with CMS to ensure that its final settlement of contract costs reflects a decrease in Medicare PRB costs of $1,622,214 for CYs 2009 through 2016.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $1,622,214
- Last Update Received
- -
- Closed Date
- 03/05/2021
- Legislative Related
- No
-
The National Institutes of Health Should Improve Its Stewardship and Accountability Over Hardware and Software Assets
20-A-18-155.01We recommend that the National Institutes of Health establish an oversight body that ensures property accountability management responsibilities and control activities for Government property are performed.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 10/01/2024
- Next Update Expected
- 04/03/2025
- Legislative Related
- No
20-A-18-155.02We recommend that the National Institutes of Health appoint a Board of Survey and Survey officers at each IC and complete investigations and reviews on incidents to accountable property, and conduct them going forward according to property management policy and procedures.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 10/01/2024
- Next Update Expected
- 04/03/2025
- Legislative Related
- No
20-A-18-155.03We recommend that the National Institutes of Health formalize and implement a performance indicator for the completion of investigations for lost, damaged, stolen, or destroyed accountable property and risk indicators to use together with other performance indicators in its accountable personal property management program.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 10/01/2024
- Next Update Expected
- 04/03/2025
- Legislative Related
- No
20-A-18-155.04We recommend that the National Institutes of Health implement routine mandatory training for ICs' procurement personnel and Property Custodial and Accountability officers on its Personal Property Management policies and procedures.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 10/01/2024
- Next Update Expected
- 04/03/2025
- Legislative Related
- No
20-A-18-155.05We recommend that the National Institutes of Health complete corrective actions for FYs 2017 and 2018 FMFIA audits' control deficiency record.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 10/01/2024
- Next Update Expected
- 04/03/2025
- Legislative Related
- No
20-A-18-155.06We recommend that the National Institutes of Health develop relevant milestones with estimated milestone completion dates that support the implementation of a standardized agencywide operating model that centralizes and integrates software asset management and software license management.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/08/2023
- Legislative Related
- No
20-A-18-155.07We recommend that the National Institutes of Health employ a primary software asset management tool that centralizes and automates the capture of software inventory and entitlement data into each IC operating environment.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/03/2024
- Legislative Related
- No
-
Billions in Estimated Medicare Advantage Payments From Diagnoses Reported Only on Health Risk Assessments Raise Concerns
20-E-03-039.01CMS should require MAOs to implement best practices to ensure care coordination for HRAs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 11/30/2022
- Next Update Expected
- 12/14/2023
- Legislative Related
- No
20-E-03-039.02CMS should provide targeted oversight of the 10 parent organizations that drove most of the risk-adjusted payments resulting from in-home HRAs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/21/2021
- Next Update Expected
- 03/08/2023
- Legislative Related
- No
20-E-03-039.03CMS should provide targeted oversight of the 20 MAOs that drove risk-adjusted payments resulting from in-home HRAs for beneficiaries who had no other service records in the 2016 encounter data.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/21/2021
- Next Update Expected
- 03/08/2023
- Legislative Related
- No
20-E-03-039.04CMS should reassess the risks and benefits of allowing in-home HRAs to be used as sources of diagnoses for risk adjustment and reconsider excluding such diagnoses from risk adjustment.- Status
- Closed Superseded
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/19/2025
- Legislative Related
- No
20-E-03-039.05CMS should require MAOs to flag any MAO-initiated HRAs in their MA encounter data.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 11/30/2022
- Next Update Expected
- 12/14/2023
- Legislative Related
- No
-
Indiana Did Not Ensure That Medicaid Payments Were Made Properly for Some Claims Identified as Having Third-Party Coverage
20-A-05-154.01We recommended that the Indiana Family and Social Services Administration, Office of Medicaid Policy and Planning refund $36,573 to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $36,573
- Last Update Received
- -
- Closed Date
- 02/08/2022
- Legislative Related
- No
20-A-05-154.02We recommended that the Indiana Family and Social Services Administration, Office of Medicaid Policy and Planning work with DXC to ensure that providers submit billed amounts and third-party payment amounts that match the claims billed to the third-party carrier.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/21/2022
- Legislative Related
- No
20-A-05-154.03We recommended that the Indiana Family and Social Services Administration, Office of Medicaid Policy and Planning work with DXC to ensure that Medicaid claims are priced correctly.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/08/2022
- Legislative Related
- No
20-A-05-154.04We recommended that the Indiana Family and Social Services Administration, Office of Medicaid Policy and Planning work with DXC to ensure that CoreMMIS contains accurate and complete information to avoid paying claims when a third party is liable, including all active third-party carriers and policies, and all third-party coverage benefits (and the system is allowed to generate provider inquiry letters for Medicaid claims with benefits not included in CoreMMIS).- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/09/2023
- Legislative Related
- No
20-A-05-154.05We recommended that the Indiana Family and Social Services Administration, Office of Medicaid Policy and Planning work with DXC to ensure that CoreMMIS contains accurate and complete information to avoid paying claims when a third party is liable, including accurate third-party coverage dates.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/09/2023
- Legislative Related
- No
20-A-05-154.06We recommended that the Indiana Family and Social Services Administration, Office of Medicaid Policy and Planning work with DXC to ensure that HMS has accurate and complete Medicaid claim information to bill third-party carriers.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/09/2023
- Legislative Related
- No
20-A-05-154.07We recommended that the Indiana Family and Social Services Administration, Office of Medicaid Policy and Planning work with DXC to ensure that HMS has accurate and complete third-party policy information, and addresses system edits preventing billing to third-party carriers.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/10/2022
- Legislative Related
- No
20-A-05-154.08We recommended that the Indiana Family and Social Services Administration, Office of Medicaid Policy and Planning work with DXC to ensure that when HMS recovers Medicaid excess payments from third-party carriers that exceed the total Medicaid payment on a claim, HMS determines whether the member has other Medicaid expenditures to which the excess payments recovered could be applied.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/21/2022
- Legislative Related
- No
20-A-05-154.09We recommended that the Indiana Family and Social Services Administration, Office of Medicaid Policy and Planning work with DXC to ensure that HMS pursues recovery of Medicaid payments in a timely manner for claims with TPL.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/10/2022
- Legislative Related
- No
-
Baylor Scott & White—College Station: Audit of Outpatient Outlier Payments
20-A-06-151.01We recommend that Baylor Scott & White - College Station refund to the Medicare contractor the portion of the $189,27637 in estimated overpayments for incorrectly billed claims that are within the 4-year reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $189,276
- Last Update Received
- -
- Closed Date
- 12/31/2021
- Legislative Related
- No
20-A-06-151.02We recommend that Baylor Scott & White-College Station 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
- $93,957
- Last Update Received
- -
- Closed Date
- 03/14/2022
- Legislative Related
- No
20-A-06-151.03We recommend that Baylor Scott & White-College Station improve procedures and provide education to ensure claims billed to Medicare are accurate.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/17/2020
- Legislative Related
- No
20-A-06-151.04We recommend that Baylor Scott & White-College Station implement changes to billing system to ensure claims billed to Medicare are accurate.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/17/2020
- Legislative Related
- No
-
Hawaii's Monitoring Generally Ensured Child Care Provider Compliance With State Criminal Background Check Requirements
20-A-09-152.01We recommend that the Hawaii Department of Human Services confirm that the licensing unit responsible for the child-care-center provider that did not complete a required criminal background check has implemented a corrective action plan to ensure that background checks are completed for all staff who have been fingerprinted.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/20/2020
- Legislative Related
- No
-
National Background Check Program for Long Term Care Providers: Assessment of State Programs Concluded in 2019
20-E-07-038.01CMS should assist participating States in addressing the challenge of coordination between State-level departments.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/14/2022
- Legislative Related
- No
20-E-07-038.02CMS should require that participating States consistently submit data that allow for CMS and each State to calculate determinations of ineligibility.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/30/2024
- Legislative Related
- No
-
Medicare Hospital Provider Compliance Audit: Flagstaff Medical Center
20-A-07-149.01We recommend that Flagstaff Medical Center refund to the Medicare contractor $79,216 in estimated overpayments for the audit period for claims that it incorrectly billed.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $79,216
- Last Update Received
- -
- Closed Date
- 01/05/2021
- Legislative Related
- No
20-A-07-149.02We recommend that Flagstaff Medical Center based on the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule,8 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
- 01/05/2021
- Legislative Related
- No
20-A-07-149.03We recommend that CMS strengthen controls to ensure full compliance with Medicare requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/05/2021
- Legislative Related
- No
-
Colorado Claimed Unsupported and Incorrect Federal Medicaid Reimbursement for Beneficiaries Enrolled in the New Adult Group
20-A-07-150.01We recommend that the Colorado Department of Health Care Policy and Financing update the CBMS by implementing an automatically accessible eligibility history that retains all beneficiary histories when retroactive changes occur, thereby eliminating the need for manual interventions to identify changes in eligibility status.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/18/2025
- Legislative Related
- No
20-A-07-150.02We recommend that the Colorado Department of Health Care Policy and Financing ensure that the MMIS retains all beneficiary eligibility changes and reconcile the beneficiaries' data contained in the MMIS to the data in the CBMS to determine whether discrepancies in Medicaid eligibility groups are occurring.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/20/2024
- Legislative Related
- No
20-A-07-150.03We recommend that the Colorado Department of Health Care Policy and Financing ensure that the CBMS has automated edits to enroll Transitional Medicaid beneficiaries in the correct eligibility group.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/23/2024
- Legislative Related
- No
-
Indiana's Monitoring Did Not Ensure Child Care Provider Compliance With State Criminal Background Check Requirements at 17 of 30 Providers Reviewed
20-A-05-148.01We recommend that the Indiana Family and Social Services Administration conduct all required criminal background checks for the 56 individuals we reviewed who did not have all required background checks at the time of our data requests and site visits.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Partial Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/06/2023
- Legislative Related
- No
20-A-05-148.02We recommend that the Indiana Family and Social Services Administration verify that the disqualified employee was terminated and not allowed onsite.- Status
- Closed Acceptable Alternative
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/06/2023
- Legislative Related
- No
20-A-05-148.03We recommend that the Indiana Family and Social Services Administration conduct the required criminal background checks on all new employees and new household members.- Status
- Closed Acceptable Alternative
- Responsible Agency
- ACF
- Response
- Partial Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/06/2023
- Legislative Related
- No
20-A-05-148.04We recommend that the Indiana Family and Social Services Administration develop a system that regularly notifies providers to initiate required background check procedures for all new employees and notifies providers when background check applications have not been received or fully processed.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Partial Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/06/2023
- Legislative Related
- No
-
Texas Relied on Impermissible Provider-Related Donations To Fund the State Share of the Medicaid Delivery System Reform Incentive Payment Program
20-A-06-147.01We recommend that the Texas Health and Human Services Commission refund $83,833,972 in Federal funds it inappropriately received because it used IGTs derived from impermissible provider-related donations to fund the State share of DSRIP Program payments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $83,833,972
- Last Update Received
- 09/25/2025
- Next Update Expected
- 03/25/2026
- Legislative Related
- No
20-A-06-147.02We recommend that the Texas Health and Human Services Commission provide its IGT entities with guidance about arrangements that may result in impermissible provider-related donations, such as those outlined in CMS's clarifying letter.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/25/2025
- Next Update Expected
- 03/25/2026
- Legislative Related
- No
20-A-06-147.03We recommend that the Texas Health and Human Services Commission request that its IGT entities disclose if similar arrangements exist and provide the State agency with action plans on ending the arrangements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/25/2025
- Next Update Expected
- 03/25/2026
- Legislative Related
- No
-
Michigan Did Not Bill Manufacturers for Some Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations
20-A-05-143.01We recommend that the Michigan Department of Health and Human Services bill for and collect manufacturers' rebates for pharmacy drugs and for single-source and top-20 multiple-source physician-administered drugs that we calculated to be at least $30,031,147 (Federal share) and refund the Federal Government.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $30,031,147
- Last Update Received
- 10/27/2022
- Next Update Expected
- 04/27/2023
- Legislative Related
- No
20-A-05-143.02We recommend that the Michigan Department of Health and Human Services work with CMS to determine whether the non-top-20 multiple-source physician-administered drugs and other physician-administered drugs without NDCs were eligible for rebates that we calculated to be at least $1,460,089 (Federal share) and, if so, upon receipt of the rebates, refund the Federal share of the rebates collected.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 10/27/2022
- Next Update Expected
- 04/27/2023
- Legislative Related
- No
20-A-05-143.03We recommend that the Michigan Department of Health and Human Services work with CMS to ensure that all pharmacy and physician-administered drugs eligible for rebates after our audit period are processed for rebates.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/09/2021
- Legislative Related
- No
20-A-05-143.04We recommend that the Michigan Department of Health and Human Services improve the processes for determining drug rebate eligibility to ensure that all rebate-eligible pharmacy and physician-administered drugs contained in the drug utilization data submitted by the MCOs are identified and billed for rebates.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/09/2021
- Legislative Related
- No
-
Medicare Contractors Were Not Consistent in How They Reviewed Extrapolated Overpayments in the Provider Appeals Process
20-A-05-144.01We recommend that the Centers for Medicare & Medicaid Services provide additional guidance to MACs and QICs to ensure reasonable consistency in procedures used to review extrapolated overpayments during the first two levels of the Medicare Parts A and B appeals process.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/12/2021
- Legislative Related
- No
20-A-05-144.02We recommend that the Centers for Medicare & Medicaid Services take steps to identify and resolve discrepancies in the procedures that MACs and QICs use to review extrapolations during the appeals process.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/12/2021
- Legislative Related
- No
20-A-05-144.03We recommend that the Centers for Medicare & Medicaid Services provide guidance to the program integrity contractors regarding the organization of extrapolation-related files that must be submitted in response to a provider appeal.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/26/2022
- Legislative Related
- No
20-A-05-144.04We recommend that the Centers for Medicare & Medicaid Services improve system controls to reduce the risk of MACs and QICs incorrectly marking the extrapolation flag field in the MAS.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/04/2021
- Legislative Related
- No
20-A-05-144.05We recommend that the Centers for Medicare & Medicaid Services update the information in the MAS to accurately reflect extrapolation amounts challenged as part of an appeal, whether the extrapolation was reviewed by a contractor, and the outcome of any extrapolation review.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/29/2023
- Legislative Related
- No
-
Illinois Claimed Unallowable Telemedicine Payments
20-A-05-145.01We recommend that the Illinois Department of Healthcare and Family Services refund $124,812 to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $124,812
- Last Update Received
- -
- Closed Date
- 02/08/2022
- Legislative Related
- No
20-A-05-145.02We recommend that the Illinois Department of Healthcare and Family Services give providers formal training on telemedicine billing requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/26/2022
- Legislative Related
- No
20-A-05-145.03We recommend that the Illinois Department of Healthcare and Family Services enhance the monitoring of provider compliance by conducting periodic reviews of telemedicine payments for compliance with billing requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/26/2022
- Legislative Related
- No
-
Indiana Paid $3.5 Million for Medicaid Nonemergency Medical Transport Claims That Did Not Comply With Federal and State Requirements
20-A-05-146.01We recommend that the State agency refund $3,485,563 to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $3,485,563
- Last Update Received
- -
- Closed Date
- 02/10/2022
- Legislative Related
- No
20-A-05-146.02We recommend that the State agency improve its oversight and monitoring of its Medicaid FFS NEMT program by requiring its broker to have procedures in place to ensure that NEMT services are adequately documented and the documentation is maintained according to Federal and State regulations.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/03/2021
- Legislative Related
- No
20-A-05-146.03We recommend that the State agency improve its oversight and monitoring of its Medicaid FFS NEMT program by requiring its broker to have procedures in place to ensure that transportation provider qualifications meet State requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/03/2021
- Legislative Related
- No
-
CMS's Encounter Data Lack Essential Information That Medicare Advantage Organizations Have the Ability to Collect
20-E-03-037.01CMS should require MAOs to submit the ordering provider NPI on encounter records for DMEPOS and for laboratory, imaging, and home health services.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 08/13/2025
- Next Update Expected
- 09/02/2026
- Legislative Related
- No
20-E-03-037.02CMS should establish and implement “reject edits” that (1) reject encounter records in which the ordering provider NPI is not present when required and (2) reject encounter records that contain an ordering provider NPI that is not a valid and active NPI in the NPPES registry.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 03/02/2021
- Next Update Expected
- 02/23/2021
- Legislative Related
- No
-
CMS Generally Met Requirements for the DMEPOS Competitive Bidding Program Round 1 Recompete
20-A-05-141.01We recommend that CMS follow its established Program procedures and applicable Federal requirements consistently in evaluating the financial documents of all suppliers.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/29/2023
- Legislative Related
- No
20-A-05-141.02We recommend that CMS ensure that suppliers have the applicable licenses for the specific competitions in which they are submitting a bid by continuing to work with State licensing boards, as recommended in our previous report.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 08/01/2024
- Next Update Expected
- 02/05/2025
- Legislative Related
- No
20-A-05-141.03We recommend that CMS ensure that it has a system to monitor supplier licensure requirements and identify potentially unlicensed suppliers.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/30/2025
- Legislative Related
- No
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New Jersey Did Not Ensure That Incidents of Potential Abuse or Neglect of Medicaid Beneficiaries Residing in Nursing Facilities Were Always Properly Investigated and Reported
20-A-02-140.01We recommend that the New Jersey Department of Human Services (NJDHS) work with the New Jersey Department of Health to reinforce guidance to nursing facilities for ensuring potential incidents of abuse or neglect are reported in accordance with Federal and State requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/18/2020
- Next Update Expected
- 08/19/2022
- Legislative Related
- No
20-A-02-140.02We recommend that the New Jersey Department of Human Services work with the New Jersey Department of Health to develop additional procedures for its survey site visits, including reviewing nursing facilities' records related to hospital transfers for certain beneficiary injuries or conditions that could be the result of potential abuse or neglect.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/18/2020
- Next Update Expected
- 08/19/2022
- Legislative Related
- No
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Rhode Island's Monitoring Did Not Ensure Child Care Provider Compliance With State Criminal Background Check Requirements at 18 of 30 Providers Reviewed
20-A-01-137.01We recommend that the Rhode Island Department of Human Services conduct or renew all required criminal background checks for the 108 individuals we reviewed who did not have all required checks or who had expired background checks at the time of our data request and site visits.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/13/2021
- Legislative Related
- No
20-A-01-137.02We recommend that the Rhode Island Department of Human Services determine whether it is feasible to develop a centralized process to monitor both family homes and childcare centers.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/13/2021
- Legislative Related
- No
20-A-01-137.03We recommend that the Rhode Island Department of Human Services determine whether it is feasible to increase the ratio of State licensing inspectors to child care providers to meet industry standards so that it can review all employee criminal background checks at all child care providers.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/13/2021
- Legislative Related
- No
20-A-01-137.04We recommend that the Rhode Island Department of Human Services require the State licensing agency to increase the number of current employees it reviews at all child care centers to ensure child care provider compliance with criminal background check requirements.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/13/2021
- Legislative Related
- No