Recommendations Tracker

We recommend that the State agency ensure that the 105 instances of noncompliance with health and safety and administrative requirements identified in this report are corrected.

We recommended that the State agency consider developing templates for administrative records the State requires.

We recommend that FCSO work with CMS to ensure that FCSO's final settlement of contract costs reflects a decrease in Medicare pension costs of $43,835 for CYs 2008 through 2010.

We recommend that FCSO work with CMS to ensure that FCSO's final settlement of contract costs reflects an increase in Medicare SERP costs of $1,064,636 for CYs 2008 through 2010.

CMS should work with States to improve managed care organization (MCO) identification and referral of cases of suspected fraud or abuse.

CMS should work with States to clarify the information managed care organizations are required to report regarding providers who are terminated or otherwise leave the managed care organization network.

CMS should work with States to improve coordination between MCOs and other State program integrity entities.

CMS should work with States to ensure that managed care organizations provide complete, accurate, and timely encounter data.

CMS should require plan sponsors to report Part C and Part D fraud and abuse incidents and the corrective actions taken to address them to a centralized system.

CMS should require that Part C and Part D providers and pharmacies enroll in Medicare.

CMS should ensure that the MEDIC has the ability to require medical records from prescribers of Part D drugs not under contract with plan sponsors, obtaining legislative authority, if necessary.

We recommend that the Office of the Secretary review the lack of compliance with the OMB Circular A-126, Federal Travel Regulations, and HHS Travel Policy Manual related to the authorization and use of chartered aircraft during former Secretary Price's tenure, and on the basis of the review, determine and take appropriate administrative actions to recoup $333,014 of identified waste, including the $12,178 for the June 6 trip to Nashville for which the chartered aircraft was not cancelled after receiving confirmation that the White House event would not occur, providing an opportunity for the use of commercial flights; the $36,313 for the June 24–26 trip to San Diego, Aspen, and Salt Lake City that included only 3.5 hours of official engagements; the $10,001 for the September 15 trip to Philadelphia for not using options other than chartered aircraft; the $12,346 for the Raleigh to Brunswick travel leg in which former Secretary Price used the chartered aircraft to attend an event in a p

We recommend that the Office of the Secretary review the lack of compliance with the FTR and the HHS Travel Policy Manual related to other excess travel costs, and on the basis of the review, determine and take appropriate action to recoup $2,960 of identified waste the $1,568 of excess lodging costs that were not pre-authorized; the $727 of excess costs incurred for a rental vehicle and pre-paid fuel; and the $665 to Government travelers for travel costs that included unallowable meal costs and incorrect amounts entered on vouchers.

We recommend that the Office of the Secretary train responsible HHS personnel and put controls in place to ensure that the following requirements are met for future procurements; preparing and maintaining documentation regarding the rationale for quote selections when the lowest quote is not selected is prepared and included in the contract file as required by the FAR; and verifying that sole-source justification requirements are adhered to and documentation related to sole-source awards is prepared in accordance with the FAR.

We recommend that the Office of the Secretary assess the roles, responsibilities, and actions of Federal personnel involved in scheduling, preparing, procuring, and approving the use of chartered aircraft for former Secretary Price's travel and take all appropriate actions related to their performance or conduct.

We recommend that CMS direct the Medicare contractors to recover the portion of the $8,633,940 in improper payments made to providers for claim lines that are within the 4-year claim-reopening period.

We recommend that CMS direct the Medicare contractors to review claim lines for nonemergency ambulance transports to destinations not covered by Medicare after our audit period and recover any improper payments identified.

We recommend that the Colorado marketplace refund to the Federal Government $1,998,617 in costs that were improperly transferred between grants.

We recommend that the Colorado marketplace work with CMS to certify the cost transfers associated with the remaining 352 expenditures totaling $3,177,310, ensure that each expenditure transferred was allowable, and refund any unallowable expenditures to the Federal Government.

We recommend that IHS strengthen controls to ensure that purchase cardholders comply with Federal requirements and IHS's own policy by ensuring that purchase card usage is adequately monitored for compliance with Federal requirements and IHS's own policy.

Direct the Medicare contractors to recover the portion of the $6,682,531 in overpayments to providers for claims that are within the reopening period in accordance with CMS's policies and procedures.

Revise the claims processing edits to ensure that all claims for items and services ordered by chiropractors are denied.

We recommend that ACF follow its policies and procedures to ensure that management decisions are issued within the required 6-month resolution period,

We recommend that ACF follow its recently implemented procedures by reconciling each month the OIG stewardship reports with ACF's internal audit tracking and monitoring system and following up on any differences noted.

CMS should improve oversight of place-of-service codes submitted by DME suppliers for DME provided during noncovered SNF stays.

CMS should assess the costs and benefits of collecting and maintaining information regarding the level of care provided by Medicaid-only nursing facilities.

CDC should clarify the requirement for internal inspections.

For DSAT inspectors, develop and provide additional training.

We recommend that the State agency refund to the Federal government $7,674,911 for administrative costs that were not identified in the CAP.

Repay Federal matching funds spent on cases that were ineligible for Federal funding and ensure that cases worked are within grant authority.

Continue to pursue its proposed expansion plan and work towards increasing Unit staff size to be commensurate with Medicaid program expenditures.

We recommend that the State agency ensure that the health and safety issues noted in this report are corrected.

We recommend that the State agency seek a change to State law to allow private school providers to access the Statewide Central Register of Child Abuse and Maltreatment or take other steps to ensure that required background checks are completed.

We recommend that Crittenton ensure that all required background checks are conducted and documented.

We recommend that Crittenton increase oversight of its quality review for UAC case files to ensure that all required documentation is maintained in the files.

We recommend that Crittenton develop a process to document the information used to prepare its quarterly performance reports and verify the information's accuracy.

We recommend that the State agency refund $4,503,738 to the Federal Government.

We recommend that the State agency strengthen its controls over its process for reporting expenditures claimed for NEMT services.

We recommended that CMS instruct the Medicare contractors to recover the portion of the overpayments of $13,414 associated with the 86 sample claims that are within the 4-year reopening period.

We recommended that CMS instruct the Medicare contractors to notify 82 suppliers, associated with 86 claims with potential overpayments of $13,414, to exercise reasonable diligence to investigate and return any identified overpayments, in accordance with the 60-day rule, and to identify and track any returned overpayments as having been made in accordance with this recommendation.

We recommend that CDS work with CMS to ensure that its final settlement of contract costs reflects an increase in Medicare pension costs of $17,943 for CYs 2008 through 2011.