Recommendations Tracker

We recommend that the Georgia Department of Community Health improve its oversight and monitoring of providers.

We recommend that the Georgia Department of Community Health refund to the Federal Government $9,325 (Federal share) for top-20 multiple-source physician-administered drug claims that were ineligible for Federal reimbursement.

We recommend that the Georgia Department of Community Health complete the process for rebating pharmacy drug claims totaling $1,240,894 (Federal share) for single-source and $360,454 (Federal share) for multiple-source drugs that it had not previously sent for invoicing or refund the Federal share.

We recommend that the Georgia Department of Community Health strengthen its internal controls to ensure that all pharmacy and physician-administered drugs eligible for rebates are invoiced.

We recommend that the Centers for Medicare and Medicaid Services instruct the MACs to, based on the results of this audit, notify appropriate physicians (i.e. those for whom CMS determines this audit constitutes credible information of potential overpauments) so that the physicians can 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.

We recommended that Centers for Medicare and Medicaid Services direct the MACs (or other CMS-designated entities) to review a sample of claims for epidural steroid injection sessions administered during the period beginning on January 1, 2021, and ending on the date that the revised coverage limitations (i.e., up to four sessions per 12-month period) became effective in the relevant MAC's jurisdiction (I.e. December 5, 2021, and June 19, 2022), to identify instances in which Medicare paid physicians for injection sessions that exceeded the number of allowable sessions (in accordance with the applicable LCDs) and recover any improper payments identified.

We recommend that the Michigan Department of Health assess the effectiveness of all required NIST SP 800-53 controls according to the organization's defined frequency.

We recommend that the Texas Health and Human Services Commission provide its IGT entities with guidance on identifying and documenting the permissibility of the funds they transfer to cover the State share of Medicaid expenditures, emphasizing that the State is required to maintain records that adequately identify the source and application of funds for federally funded activities.

We recommend that the Florida Agency for Health Care Administration work with CMS to determine whether the other claims for multiple-source physician-administered drugs, totaling $40,635 ($24,772 Federal share), were eligible for rebates and, if so, determine the rebates due and, upon receipt of the rebates, refund the Federal share of the rebates collected.

We recommend that the Centers for Medicare & Medicaid Services work with its plan sponsors to identify and delete any unallowable PDEs related to the $19,704,602 of Medicare Part D total costs for beneficiaries whose most recent Medicare claim with a cancer diagnosis was for services provided more than 1 year before the TIRF drugs were dispensed, and determine the impact to the Federal Government.

We recommend that the Centers for Medicare & Medicaid Services work with its plan sponsors to expand the required PDE data elements to include diagnosis codes to enable plan sponsors to confirm that TIRF drugs are prescribed for a medically accepted indication.

We recommend that the Centers for Medicare & Medicaid Services review at-risk payments made to at-risk providers during and after our audit period to determine whether payments for procedure code G0483 complied with Medicare requirements and recover any overpayments.

We recommend that the Centers for Medicare & Medicaid Services educate providers that received payments that did not comply with Medicare requirements for definitive drug testing services.

We recommend that the Missouri Department of Social Services work with CMS to determine the allowability of $87,018,594 (Federal share) that we have set aside, and refund to the Federal Government any amount that is determined to be unallowable.

We recommend that the Missouri Department of Social Services establish policies and procedures to ensure that timesheets include fully accurate and complete details on the specific tasks performed.

We recommend that the Health Resources and Services Administration update security configurations to align with the most current NIST SP 800-53 security controls.

We recommend that the Florida Agency for Health Care Administration work with CMS to consider the potential use of T-MSIS data to identify potential cases of concurrent enrollment.

We recommend that the Michigan Department of Health and Human Services ensure the electronic case records for children who are prescribed psychotropic medications are maintained in accordance with requirements by implementing policies specific to non-emergency situations that require the FC-PMOU to document when consent forms do not need to be obtained; implementing procedures for caseworkers and the FC-PMOU to monitor the Medicaid claim data to ensure consent forms are obtained and documented; and implementing procedures requiring caseworkers and the FC-PMOU to monitor other medications prescribed for children, including opioids, for potential medication interaction and adverse side effects.

We recommend that the North Carolina Department of Health and Human Services, Division of Health Benefits refund to the Federal Government $733,535 (Federal share) for claims for top-20 multiple-source physician-administered drugs that were ineligible for Federal reimbursement.

We recommend that the North Carolina Department of Health and Human Services, Division of Health Benefits work with CMS to determine and refund the unallowable portion of Federal reimbursement for physician-administered drugs that were not invoiced for rebates after December 31, 2019.

CDC should strengthen reporting of vaccine allocation data and administration data.

CDC should work with awardees to enhance current and future capabilities for provider training and oversight.

CDC should provide educational outreach to ensure that State and local immunization programs are aware of existing tools to address vaccination campaign needs.

Work with ACF to determine the amount of allowable vehicle costs or refund $92,678 to the Federal Government for potentially unallowable vehicle costs.

We recommend that the National Institutes of Health implement enhanced monitoring, documentation, and reporting requirements for recipients with foreign subrecipients.

We recommend that the National Institutes of Health ensure that administrative actions such as terminations are performed in compliance with Federal regulations and HHS policies and procedures, and appropriate notifications of appeal rights are provided.

We recommend that the National Institutes of Health work with EcoHealth to determine whether EcoHealth had any unreimbursed costs at the time award R01AI110964 was terminated.

We recommend that the National Institutes of Health based on information provided in this audit and any other information available to NIH, consider whether it is appropriate to refer WIV to HHS for debarment and exercise continued monitoring and enforcement activities as appropriate over the course of the grant awards and subawards.

We recommend that EcoHealth Alliance prepare subaward and consultant agreements that contain all required information and are accurate.

We recommend that EcoHealth Alliance comply with requirements to immediately notify NIH of conditions that materially impact the ability to meet award objectives.

We recommend that EcoHealth Alliance properly identify subawards in financial statements.

We recommend EcoHealth Alliance refund to the Government $89,171 in unallowable costs consisting of: 1. salary costs claimed in excess of the NIH salary cap totaling $10,627; 2. bonus costs totaling $15,977; 3. indirect and fringe benefits associated with salary and bonus costs totaling $17,836; 4. Ph.D. education tuition costs totaling $13,951 and associated indirect costs of $4,641; 5. Indirect costs totaling $13,037 claimed by a subrecipient; 6. travel costs totaling $5,752 and associated indirect costs of $1,876; 7. visa costs of $2,500 and associated indirect costs of $896; 8. subaward costs of $2,052; and 9. professional fees costs of $19 and associated indirect costs of $7.