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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—a subset that we think, if implemented, would have the most impact (learn more). Notable differences from our previous Top Unimplemented Recommendations report include:

  • The list is comprised of individual recommendations from OIG reports, not rolled up by topic.
  • No arbitrary cap is imposed on the number of recommendations included.
  • Status updates as recommendations are implemented.

Summary of All Recommendations

Updated Monthly · Last updated on October 17, 2024

1,328

Unimplemented
recommendations

$265.9B

Potential savingsfrom unimplemented recommendations

2,656

Implemented and Closed
recommendations since FY 2017

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OIG's Top Unimplemented Recommendations

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Comprising monetary, programmatic, legislative, and procedural recommendations related to HHS Operating Divisions, full implementation of these recommendations could produce substantial savings for the Federal Government and taxpayers and improve the operation of HHS programs.
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Showing 1–7 of 33 recommendations Sorted by oldest release date
  • Centers for Medicare and Medicaid Services
    PROGRAM
    CHANGE

    Billions in Estimated Medicare Advantage Payments From Chart Reviews Raise Concerns
    20-E-03-003.03
    CMS should reassess the risks and benefits of allowing chart reviews that are not linked to service records to be used as sources of diagnoses for risk adjustment.
    PROGRAM
    CHANGE
    Implementation requires the responsible agency to change a program’s policies, activities, requirements, etc.

    Status
    Open Unimplemented
    Issued to CMS
    12/10/2019
    Evaluation Report
    OEI-03-17-00470
  • Centers for Medicare and Medicaid Services
    PROGRAM
    CHANGE

    CMS's Encounter Data Lack Essential Information That Medicare Advantage Organizations Have the Ability to Collect
    20-E-03-037.01
    CMS should require MAOs to submit the ordering provider NPI on encounter records for DMEPOS and for laboratory, imaging, and home health services.
    PROGRAM
    CHANGE
    Implementation requires the responsible agency to change a program’s policies, activities, requirements, etc.

    Status
    Open Unimplemented
    Issued to CMS
    08/24/2020
    Evaluation Report
    OEI-03-19-00430
  • Centers for Medicare and Medicaid Services
    PROGRAM
    CHANGE

    Billions in Estimated Medicare Advantage Payments From Diagnoses Reported Only on Health Risk Assessments Raise Concerns
    20-E-03-039.04
    CMS 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.
    PROGRAM
    CHANGE
    Implementation requires the responsible agency to change a program’s policies, activities, requirements, etc.

    Status
    Open Unimplemented
    Issued to CMS
    09/08/2020
    Evaluation Report
    OEI-03-17-00471
  • Centers for Medicare and Medicaid Services
    PROCESS
    CHANGE

    Nearly All States Made Capitation Payments for Beneficiaries Who Were Concurrently Enrolled in a Medicaid Managed Care Program in Two States
    22-A-05-095.01
    We recommend that the Centers for Medicare & Medicaid Services provide States with matched T-MSIS enrollment data that identify Medicaid beneficiaries who were concurrently enrolled in a Medicaid managed care program in two States.
    PROCESS
    CHANGE
    Implementation requires the responsible agency to change a program’s system or procedure.

    Status
    Open Unimplemented
    Issued to CMS
    09/19/2022
    Audit Report
    A-05-20-00025
  • Centers for Medicare and Medicaid Services
    PROGRAM
    CHANGE

    High Rates of Prior Authorization Denials by Some Plans and Limited State Oversight Raise Concerns About Access to Care in Medicaid Managed Care
    23-E-09-029.04
    CMS should require States to implement automatic external medical reviews of upheld MCO prior authorization denials.
    PROGRAM
    CHANGE
    Implementation requires the responsible agency to change a program’s policies, activities, requirements, etc.

    Status
    Open Unimplemented
    Issued to CMS
    07/17/2023
    Evaluation Report
    OEI-09-19-00350
  • Centers for Medicare and Medicaid Services
    PROCESS
    CHANGE

    Multiple States Made Medicaid Capitation Payments to Managed Care Organizations After Enrollees' Deaths
    24-A-04-018.03
    We recommend that CMS continue to explore opportunities for using T-MSIS and SSA's DMF data to improve its oversight of the Medicaid program. Specifically, CMS should develop a process to match enrollment and payment information in T-MSIS with the DMF and provide the results of that match to States to help reduce Medicaid capitation payments made to MCOs on behalf of deceased enrollees.
    PROCESS
    CHANGE
    Implementation requires the responsible agency to change a program’s system or procedure.

    Status
    Open Unimplemented
    Issued to CMS
    11/24/2023
    Audit Report
    A-04-21-09005
  • Centers for Medicare and Medicaid Services
    PROCESS
    CHANGE

    CMS Did Not Ensure That Selected States Complied With Medicaid Managed Care Mental Health and Substance Use Disorder Parity Requirements
    24-A-02-050.01
    We recommend that the Centers for Medicare & Medicaid Services improve its oversight of States' compliance with MH/SUD parity requirements, including strengthening its followup procedures, including regular communication with States, to verify that States perform parity analyses across their MH/SUD delivery systems.
    PROCESS
    CHANGE
    Implementation requires the responsible agency to change a program’s system or procedure.

    Status
    Open Unimplemented
    Issued to CMS
    03/25/2024
    Audit Report
    A-02-22-01016