Recommendations Tracker

We recommend that the Kansas Department of Health and Environment improve its oversight of the estate recovery contractor's performance by: verifying that the contractor files liens and initiates probate in a timely manner; confirming that the contractor's current process for MMIS claims verification is accurate; and verifying that the contractor performs applicable estate recovery procedures (including the opening of cases, sending of notices, and independent asset research) for deceased Medicaid recipients.

We recommend that the Pennsylvania Department of Human Services refund $368,870,827 to the Federal Government or provide documentation that can reasonably support its allocation of health services costs to Medicaid without using unverifiable IEP ratios.

We recommend that the Pennsylvania Department of Human Services ensure that school districts verify that providers are appropriately licensed before they provide health services to students.

We recommend that the Pennsylvania Department of Human Services revise its RMTSs to include the first month of the school year.

With respect to PRF payments that were already made to providers under the Phase 2 General Distribution, we recommend that the Health Resources and Services Administration identify other providers with subsidiary organizations that had revenues included in the providers' Federal tax returns. Determine whether the payments made to the subsidiary organizations were correctly accounted for when calculating payments for the providers under the Phase 2 General Distribution. In addition, determine the amount of and seek from these providers repayment of any overpayments. If it is not feasible to review all providers, HRSA could conduct a cost-benefit analysis for conducting manual reviews to identify providers and, if the benefit outweighs the cost, it could select some providers to review.

Should HRSA need to rapidly disburse similar payments to providers in response to a future national emergency, we recommend that HRSA consider working with CMS to use the information from CMS's Provider Enrollment, Chain, and Ownership System and use Federal tax returns (e.g., Schedule R of Form 990 for information on a tax-exempt provider's subsidiary organizations), in part, to develop a more complete dataset to show parent-subsidiary relationships (to the extent they are applicable) to safeguard taxpayer money, which could have saved approximately $159,379,359 during our audit period.

Should HRSA need to rapidly disburse similar payments to providers in response to a future national emergency, we recommend that HRSA consider establishing an application and attestation portal function that requests a provider to check that the revenue amount entered in the revenue field of its application for payment is entered correctly. For example, HRSA could modify its application and attestation portal by adding a step in which, after a provider enters its revenue amount, the portal generates a new screen that displays the entered amount and requests that the provider confirm the amount. (to the extent they are applicable) to safeguard taxpayer money.

CMS should reassess nurse aide training and certification requirements.

CMS should provide effective guidance and assistance to nursing homes on how to comply with updated infection control requirements.

We recommend that MediGold identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before and after our audit period and refund any resulting overpayments to the Federal Government.

ACF should develop a reference guide to help case managers better evaluate sponsors' identity.

ACF should provide additional guidance for case managers on when to consider recommending discretionary home studies.

ACF should develop an effective monitoring mechanism to identify children who do not receive timely followup calls after their release to sponsors.

Brown & Company recommends that the NIH conduct a system-level risk assessment for the SRA in accordance with NIST SP 800-53 requirements and NIH polices.

We recommend that the Colorado Department of Health Care Policy & Financing work with CMS to develop a risk-based approach to identify nursing homes at which surveys would be conducted more frequently than once every 15 months, such as those with a history of multiple high-risk deficiencies or frequent management turnover.

We recommend that the Choctaw Nation request and review agency contractor background investigations that comply with the ICPFVPA, including documentation that confirms HHS employees met all background investigation requirements of the ICPFVPA, or perform background investigations on these individuals that comply with the ICPFVPA.

We recommend that the Cherokee Nation perform background investigations, as required by the ICPFVPA, on the employees and volunteers we identified as not having complete background investigations who currently have contact with Indian children and determine whether these individuals meet the required minimum character standards.

We recommend that the Cherokee Nation request and review agency contractor background investigations that comply with the ICPFVPA, including documentation that confirms HHS employees met all background investigation requirements of the ICPFVPA, or perform background investigations on these individuals that comply with the ICPFVPA.

We recommend that the Indian Health Service enhance Single Audit Compliance Supplement, part 4: "Agency Program Requirements," for Tribes receiving ISDEAA funds from IHS by: establishing special tests and audit procedures in the annual Single Audit Compliance Supplement for all its ISDEAA programs to ensure that the ICPFVPA's requirements are tested during a review of a Tribal health program as part of the single audit, and reviewing the results of those special tests and audit procedures in the annual single audits for Tribal health programs to help assess whether Tribes are complying with ICPFVPA requirements to conduct background investigations and meet minimum standards of character.

We recommend that the Indian Health Service provide Tribes with documentation that confirms that current HHS employees assigned to Tribal health programs met all background investigation requirements of the ICPFVPA.

CDC should take further steps to ensure the quality of nursing home reporting of COVID-19 data to NHSN.

We recommend that the Oklahoma State Department of Health follow up with the 20 nursing homes reviewed in this audit that demonstrated life safety, emergency preparedness, and infection control deficiencies to ensure that they have taken corrective actions and work with CMS to develop an approach to identify nursing homes where surveys should be conducted more frequently than once every 15 months, such as those with a history of multiple deficiencies or frequent management turnover.

We recommend that Cahaba Safeguard Administrators, LLC, develop quality assurance procedures, to include improved policies and procedures, to ensure that going forward, it calculates Medicare segment pension assets in accordance with Federal requirements.

We recommend that the Ohio Department of Health work with CMS to develop a risk-based approach to identify nursing homes where surveys should be conducted more frequently than once every 15 months, such as those with a history of multiple high-risk deficiencies or frequent management turnover.

We recommend that the Ohio Department of Health work with CMS to develop standardized life safety training for nursing home staff.

We recommend that the Department of Health and Human Services complete implementation and testing of required cybersecurity controls for the HHS Protect system based on the appropriate security categorization, including the risk assessment and IT contingency plan.

We recommend that the California Department of Social Services coordinate with California Department of Health Care Services to modify the existing data sharing agreement to obtain access to Medicaid claim data for all medications prescribed for children under its care and supervision, to the extent allowable under California law.

We recommend that the California Department of Social Services develop and implement procedures for county agency staff to upload the court authorizations for psychotropic medications prescribed for children in foster care into CWS/CMS.