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 Sept. 11, 2026
1,051
Unimplemented
recommendations
3,529
Implemented and Closed
recommendations since FY 2017
Views
OIG Recommendations Grouped by Report
Showing 61–80 of 1,427 reports, containing 4,580 recommendations
Sorted by latest release date
-
West Virginia Did Not Obtain Rebates Associated With Millions of Dollars in Medicaid Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations
26-A-07-038.01We recommend that the West Virginia Bureau for Medical Services refund to the Federal Government $6,055,786 (Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $6,055,786
- Last Update Received
- 08/21/2026
- Next Update Expected
- 02/21/2027
- Legislative Related
- No
26-A-07-038.02We recommend that the West Virginia Bureau for Medical Services refund to the Federal Government $22,718 (Federal share) for claims for top-20 multiple-source physician-administered drugs that were ineligible for Federal reimbursement.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $22,718
- Last Update Received
- 08/21/2026
- Next Update Expected
- 02/21/2027
- Legislative Related
- No
-
Philadelphia Did Not Meet All of the Requirements for the COVID-19 Screening Testing Program at K-12 Schools
26-A-05-036.01We recommend that the Philadelphia Department of Public Health develop or update ELC procedures for compliance with Federal, subrecipient, and contract requirements, including: oversight of subrecipients to ensure background check requirements are followed and monitoring of subrecipients' contract terms and conditions.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/19/2026
- Legislative Related
- No
26-A-05-036.02We recommend that the Philadelphia Department of Public Health refund CDC $257,620 for costs reimbursed to the subrecipient that were unallowable or were overpayments.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- $257,620
- Last Update Received
- -
- Closed Date
- 08/19/2026
- Legislative Related
- No
-
ACF Can Improve Services to Homeless Youth by Strengthening Grant Recipients’ Compliance With Transitional Living Program Requirements
26-A-06-034.01We recommend that the Administration for Children and Families create guidance and provide technical assistance for TLP grant recipients related to: documenting required services in homeless youth case files, documenting required services in homeless youth case files that allows for continuity even when employees change jobs, ensuring required services are provided, and maintaining separate case files for children or infants of parenting youth.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/27/2026
- Legislative Related
- No
-
A Large Southeastern Hospital Could Improve Certain Security Controls to Enhance Its Ability to Prevent and Detect Cyberattacks
26-A-18-035.01We recommend that the Entity implement strong user identification and authentication controls for the account management web application we exploited.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 07/29/2026
- Legislative Related
- No
26-A-18-035.02We recommend that the Entity periodically assess and update user identification and authentication controls across the Entity's systems, including internet-accessible websites and applications.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 07/29/2026
- Legislative Related
- No
26-A-18-035.03We recommend that the Entity assess all web applications to determine whether any need an automated technical solution (e.g., a web-application firewall) implemented as an extra layer of security to detect and block malicious web traffic and attempts to exploit web application vulnerabilities.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 07/29/2026
- Legislative Related
- No
26-A-18-035.04We recommend that the Entity utilize a wider array of security testing tools and techniques to better detect vulnerabilities in applications before updating production systems, such as dynamic application testing tools, static application testing tools, and manual, interactive testing, as part of its security testing process prior to deploying updates to internet-accessible production systems.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 07/29/2026
- Legislative Related
- No
-
Maine Made at Least $45.6 Million in Improper Fee-for-Service Medicaid Payments for Rehabilitative and Community Support Services Provided to Children Diagnosed With Autism
26-A-01-033.01We recommend that the Maine Department of Health and Human Services refund $28,796,366 (Federal share) to the Federal Government for Fee-for-Serivce Medicaid payments for rehabilitative and community support services that did not comply with Federal and State requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $28,796,366
- Last Update Received
- 05/19/2026
- Next Update Expected
- 11/19/2026
- Legislative Related
- No
26-A-01-033.02We recommended that the Maine Department of Health and Human Services exercise reasonable diligence to review and determine whether any of the estimated ($14,163,521 Federal share) in potentially improper payments for RCS services did not comply Maine's FFS Medicaid Payments for Rehabilitative and Community Support Services with Federal and State requirements and refund the Federal share of any improper payment amount to the Federal Government.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 05/19/2026
- Next Update Expected
- 11/19/2026
- Legislative Related
- No
26-A-01-033.03We recommend that the Maine Department of Health and Human Services provide additional guidance to providers about how to document RCS services, including the information needed in session notes to support RCS services provided, billable RCS service time, and signature requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 05/19/2026
- Next Update Expected
- 11/19/2026
- Legislative Related
- No
26-A-01-033.04We recommend that the Maine Department of Health and Human Services periodically conduct a statewide postpayment review of Medicaid payments for RCS services, including reviewing medical records, and provide additional training in the areas in which errors were identified by postpayment reviews.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 05/19/2026
- Next Update Expected
- 11/19/2026
- Legislative Related
- No
-
Medicaid Agencies Made Millions in Unallowable Capitation Payments to Managed Care Organizations on Behalf of Deceased Enrollees
26-A-04-031.01We recommend that the Centers for Medicare & Medicaid Services provide the Medicaid agencies covered by our audit with our matched T-MSIS data so that the Medicaid agencies can review the capitation payments and take appropriate action to recover any unallowable payments made on behalf of enrollees whose date of death preceded the monthly service period and not already recovered during their normal review process, which could result in the Medicaid agencies recovering unallowable payments made during our audit period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/21/2026
- Legislative Related
- No
26-A-04-031.02We recommend that the Centers for Medicare & Medicaid Services explore opportunities to work with Medicaid agencies to ensure that the related provisions of the One Big Beautiful Bill Act (OBBB Act) are properly implemented. This effort could result in annual estimated savings of $207,501,380 ($138,645,710 Federal share).- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $138,645,710
- Last Update Received
- 04/30/2026
- Next Update Expected
- 10/30/2026
- Legislative Related
- No
-
Illinois Made Unallowable Managed Care Capitation Payments on Behalf of Incarcerated Medicaid Enrollees
26-A-05-028.01We recommended that the Illinois Department of Healthcare and Family Services refund $8,366,521 (Federal share) for unallowable capitation payments made on behalf of incarcerated Medicaid enrollees.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $8,366,521
- Last Update Received
- 03/12/2026
- Next Update Expected
- 09/13/2026
- Legislative Related
- No
26-A-05-028.02We recommended that the Illinois Department of Healthcare and Family Services expand its automated process that terminates managed care enrollment to include inmates housed in a non-Illinois Department of Corrections facility.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/13/2026
- Legislative Related
- No
-
Nine of Thirty Selected Assisted Living Facilities Did Not Comply With Terms and Conditions and Federal Requirements for Expending Provider Relief Fund Payments
26-A-02-027.01We recommend that the Health Resources and Services Administration require the seven ALFs that we determined as having used PRF payments for unallowable expenditures totaling $283,000 to return the unallowable amounts to the Federal Government or ensure that the ALFs properly replace the unallowable expenditures with allowable unreimbursed lost revenues or eligible expenses, if any.- Status
- Closed Implemented
- Responsible Agency
- HRSA
- Response
- Concur
- Potential Savings
- $282,676
- Last Update Received
- -
- Closed Date
- 03/18/2026
- Legislative Related
- No
26-A-02-027.02We recommend that the Health Resources and Services Administration require the two ALFs that we determined as having inaccurately calculated and reported lost revenues totaling $11 million to identify and return to the Federal Government any PRF payments used to offset inaccurately calculated lost revenues or replace them with allowable unreimbursed lost revenues or eligible expenses, if any.- Status
- Closed Implemented
- Responsible Agency
- HRSA
- Response
- Concur
- Potential Savings
- $11,009,668
- Last Update Received
- -
- Closed Date
- 03/18/2026
- Legislative Related
- No
-
Some Selected Health Centers Received Duplicate Reimbursement From HRSA For COVID-19 Testing Services
26-A-02-026.01We recommend that the Health Resources and Services Administration require the 12 health centers that charged unallowable COVID-19 supplemental grant costs to refund $313,270 to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- HRSA
- Response
- Concur
- Potential Savings
- $313,270
- Last Update Received
- -
- Closed Date
- 06/23/2026
- Legislative Related
- No
26-A-02-026.02We recommend that the Health Resources and Services Administration reiterate guidance to these 12 health centers for developing and maintaining financial management systems and internal controls that ensure that only allowable and allocable costs are charged to future HRSA programs similar in nature.- Status
- Closed Implemented
- Responsible Agency
- HRSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/23/2026
- Legislative Related
- No
-
Medicare Home Health Agency Provider Compliance Audit: Guardian Home Care, LLC
26-A-07-025.01We recommend that Guardian Home Care, LLC refund the $1,690 in overpayments to the Medicare program.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $1,690
- Last Update Received
- -
- Closed Date
- 03/25/2026
- Legislative Related
- No
26-A-07-025.02We recommend that Guardian Home Care, LLC consider conducting one or more internal audits or investigations for claims after our audit period, based on the risks identified by this audit, to identify any similar overpayments that Guardian Home Care might have received and return any identified overpayments to the Medicare program.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/25/2026
- Legislative Related
- No
-
Oklahoma Medicaid Fraud Control Unit: 2025 Inspection
26-E-07-010.01Update its policies and procedures manual to address certain aspects of its operations.- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 06/11/2026
- Next Update Expected
- 06/11/2026
- Legislative Related
- No
26-E-07-010.02Build upon its efforts to increase the volume and quality of fraud referrals from the PIU and MCOs.- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 06/11/2026
- Next Update Expected
- 06/11/2026
- Legislative Related
- No
26-E-07-010.03Take steps to mitigate investigative delays.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/01/2026
- Legislative Related
- No
26-E-07-010.04Take steps to implement a case management system capable of efficiently managing and reporting case information and performance data.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/01/2026
- Legislative Related
- No
26-E-07-010.05Take steps to conduct and document periodic supervisory reviews of cases in accordance with Unit policy.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/01/2026
- Legislative Related
- No
26-E-07-010.06Take steps to ensure that it reports all convictions and adverse actions to Federal partners within the appropriate timeframes.- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 06/11/2026
- Next Update Expected
- 06/11/2026
- Legislative Related
- No
26-E-07-010.07Revise its MOU with the State Medicaid agency to reference the CMS Performance Standard for Referrals.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/01/2026
- Legislative Related
- No
-
New Jersey Should Improve Its Oversight of Nursing Homes’ Compliance With Background Check Requirements
26-A-02-024.01We recommend that the New Jersey Department of Health strengthen its monitoring activities to ensure that nursing homes comply with requirements that prohibit the employment of individuals with disqualifying backgrounds, such as expanding the timeframe covered by recertification surveys.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/10/2026
- Legislative Related
- No
26-A-02-024.02We recommend that the New Jersey Department of Health provide guidance to nursing homes on implementing adequate procedures to ensure background checks are completed on all direct hire and contracted staff members prior to starting work in the nursing home in accordance with applicable requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/10/2026
- Legislative Related
- No
-
The National Institutes of Health Generally Implemented the Safe Workplace Federal Reporting Requirement, but Opportunities Exist To Improve the Reporting and Monitoring Processes
26-A-05-023.01We recommend that the National Institutes of Health educate recipient institutions on the importance of compliance with the CAA reporting requirement.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 06/16/2026
- Next Update Expected
- 12/16/2026
- Legislative Related
- No
26-A-05-023.02We recommend that the National Institutes of Health develop policies and procedures for monitoring of recipient institutions' compliance with the CAA reporting requirement.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/16/2026
- Legislative Related
- No
26-A-05-023.03We recommend that the National Institutes of Health develop policies and procedures to facilitate NIH's consistent, timely, and proper actions in response to reported harassment and other inappropriate conduct cases.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 06/16/2026
- Next Update Expected
- 12/16/2026
- Legislative Related
- No
-
The Indian Health Service Did Not Ensure That Commissioned Corps Officers’ Background Investigations Complied With Federal Requirements
26-A-01-022.01We recommend that the Indian Health Service work with the Office of National Security to develop policies and procedures to ensure that all Officers assigned to IHS have background investigations adjudicated according to the requirements of the ICPFVPA.- Status
- Open Unimplemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 08/05/2026
- Next Update Expected
- 02/20/2027
- Legislative Related
- No
26-A-01-022.02We recommend that the Indian Health Service work with ONS to evaluate the most recent background investigation results for all Officers assigned to IHS and determine whether the individuals meet the minimum character standards of the ICPFVPA to allow the individuals to be in contact with Indian children.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/20/2026
- Legislative Related
- No
26-A-01-022.03We recommend that the Indian Health Service determine which Officers have pending background investigations and take immediate action to ensure the supervision of these individuals when children are in their care.- Status
- Open Unimplemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 08/05/2026
- Next Update Expected
- 02/20/2027
- Legislative Related
- No
26-A-01-022.04We recommend that the Indian Health Service develop policies and procedures to communicate provisional clearance status of Officers assigned to Tribal health programs to Tribes.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/20/2026
- Legislative Related
- No
26-A-01-022.05We recommend that the Indian Health Service work with ONS to obtain full access to all Officers' background investigation data in the Security Manager system that includes criminal history results to enable a determination of the schedule for reinvestigations.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/20/2026
- Legislative Related
- No
26-A-01-022.06We recommend that the Indian Health Service develop and implement policies and procedures to identify and track when Officers background reinvestigations will expire and initiate reinvestigations within the standard timeframe.- Status
- Open Unimplemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 08/05/2026
- Next Update Expected
- 02/20/2027
- Legislative Related
- No
26-A-01-022.07We recommend that the Commissioned Corps of the United States Public Health Service work with the Office of National Security to develop policies and procedures to ensure that all Officers assigned to IHS have background investigations adjudicated according to the requirements of the ICPFVPA.- Status
- Open Unimplemented
- Responsible Agency
- OASH
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/08/2026
- Legislative Related
- No
26-A-01-022.08We recommend that the Commissioned Corps of the United States Public Health Service communicate an Officer's provisional clearance status at the time the individual is assigned to a Division and the final determination of the background investigation adjudication to Divisions.- Status
- Open Unimplemented
- Responsible Agency
- OASH
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/08/2026
- Legislative Related
- No
26-A-01-022.09We recommend that the Commissioned Corps of the United States Public Health Service maintain documentation of provisional clearance status and final determination of background investigations in Officers' eOPFs to facilitate use of the Officers' personnel records in the redetermination of their eligibility for a position.- Status
- Open Unimplemented
- Responsible Agency
- OASH
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/08/2026
- Legislative Related
- No
26-A-01-022.10We recommend that the Commissioned Corps of the United States Public Health Service collect at least annually, background investigations that have been adjudicated and enter the COIs into the Officers' eOPF.- Status
- Open Unimplemented
- Responsible Agency
- OASH
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/08/2026
- Legislative Related
- No
-
Arkansas Could Better Ensure That Intermediate Care Facilities for Individuals With Intellectual Disabilities Comply With Federal Requirements for Life Safety, Emergency Preparedness, and Infection Control
26-A-06-021.01We recommend that the Arkansas Department of Human Services follow up with the 10 ICF/IIDs to verify that they have taken corrective actions on the life safety, emergency preparedness, and infection control deficiencies identified during the audit.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/27/2026
- Legislative Related
- No
26-A-06-021.02We recommend that the Arkansas Department of Human Services work with State surveyors to include all areas of life safety, emergency preparedness, and infection control when conducting their reviews at ICF/IIDs as required by CMS.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/27/2026
- Legislative Related
- No
26-A-06-021.03We recommend that the Arkansas Department of Human Services work with CMS to develop standardized life safety, emergency preparedness, and infection control training for ICF/IID staff.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/27/2026
- Legislative Related
- No
-
Medicare Advantage Compliance Audit of Specific Diagnosis Codes Humana Health Benefit of Louisiana (Contract H1951) Submitted to CMS
26-A-06-020.01We recommend that Humana Health Benefit of Louisiana refund to the Federal Government the $5,470,725 of estimated overpayments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $5,470,725
- Last Update Received
- 04/15/2026
- Next Update Expected
- 12/05/2026
- Legislative Related
- No
26-A-06-020.02We recommend that Humana Health Benefit of Louisiana identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred 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
- 04/15/2026
- Next Update Expected
- 12/05/2026
- Legislative Related
- No
26-A-06-020.03We recommend that Humana Health Benefit of Louisiana continue to examine its existing compliance procedures to identify areas where improvements can be made to ensure that diagnoses 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
- 04/15/2026
- Next Update Expected
- 12/05/2026
- Legislative Related
- No
-
Podiatrists’ Claims for Routine Foot Care Services Did Not Comply With Medicare Requirements
26-A-09-019.01We recommend that the Centers for Medicare & Medicaid Services work with the MACs to analyze RFC care claims related to systemic conditions billed by podiatrists—specifically claims billed with E/M services—to determine whether additional oversight (e.g., guidance, education, medical reviews, and/or provider internal audits) is necessary to prevent improper payments, which amounted to an estimated $4,425,822 for our audit period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/15/2026
- Legislative Related
- No
-
Podiatrists’ Claims for Evaluation and Management Services Did Not Comply With Medicare Requirements
26-A-09-018.01We recommend that the Centers for Medicare & Medicaid Services work with MACs to determine whether additional oversight (e.g., guidance, education, medical reviews, and/or provider internal audits) is necessary to prevent improper payments associated with podiatrists' billing of E/M services with modifier 25, which amounted to an estimated $39,583,052 for our audit period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/29/2026
- Legislative Related
- No
-
Florida Retina Institute Generally Met Medicare Requirements for Ophthalmology Services Provided on the Same Day as Eye Injections
26-A-04-016.01We recommend that the Florida Retina Institute refund to the Federal Government the estimated $42,295 in Medicare overpayments for services improperly billed.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $42,295
- Last Update Received
- 02/27/2026
- Next Update Expected
- 08/27/2026
- Legislative Related
- No
-
New Jersey Did Not Ensure Providers Complied With Federal and State Requirements at All 20 Adult Day Health Services Facilities Audited
26-A-02-017.01We recommend that the New Jersey Department of Human Services work with the New Jersey Department of Health to ensure providers correct the 348 instances of noncompliance identified in this report.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/28/2026
- Legislative Related
- No
26-A-02-017.02We recommend that the New Jersey Department of Human Services work with the New Jersey Department of Health to improve its oversight and monitoring of all providers, including conducting timely surveys.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/28/2026
- Legislative Related
- No
26-A-02-017.03We recommend that the New Jersey Department of Human Services work with the New Jersey Department of Health to work with providers to improve their facilities, staffing, and training.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/28/2026
- Legislative Related
- No