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 March 26, 2026
1,162
Unimplemented
recommendations
3,267
Implemented and Closed
recommendations since FY 2017
Views
OIG Recommendations Grouped by Report
Showing 21–40 of 1,376 reports, containing 4,429 recommendations
Sorted by latest release date
-
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
- Not Yet Due
- 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
- Not Yet Due
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/09/2026
- 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
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/09/2026
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/09/2026
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/08/2026
- 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
- Open Unimplemented
- Responsible Agency
- IHS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/08/2026
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/08/2026
- 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
- Open Unimplemented
- Responsible Agency
- IHS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/08/2026
- 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
- Open Unimplemented
- Responsible Agency
- IHS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/08/2026
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/08/2026
- 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
- Not Yet Due
- 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
- Not Yet Due
- 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
- Not Yet Due
- 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
- Not Yet Due
- 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
- 01/13/2026
- Next Update Expected
- 07/14/2026
- 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
- 01/13/2026
- Next Update Expected
- 07/14/2026
- 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
- 01/13/2026
- Next Update Expected
- 07/14/2026
- 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
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/03/2026
- 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
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/02/2026
- 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
-
Medicare Improperly Paid Selected Optometrists for Services Provided to Enrollees at Nursing Facilities
26-A-05-015.01We recommend that the Centers for Medicare & Medicaid Services collaborate with CMS contractors to review all claims submitted by the 15 selected optometrists to determine compliance with Medicare requirements and recover the portion of the $3,059,204 in estimated overpayments made to those optometrists during our audit period that are within the 4-year reopening period.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $3,059,204
- Last Update Received
- -
- Next Update Expected
- 05/31/2026
- Legislative Related
- No
26-A-05-015.02We recommend that the Centers for Medicare & Medicaid Services instruct the CMS contractors to notify, as the contractors deem appropriate, providers in our sample that received an overpayment(s) to consider conducting one or more internal audits or investigations based on the risks identified by this audit to identify any similar overpayments the provider might have received and return any identified funds to the Medicare program.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/31/2026
- Legislative Related
- No
26-A-05-015.03We recommend that the Centers for Medicare & Medicaid Services instruct CMS contractors to provide training and guidance that are specific to Medicare requirements for billing optometrist services provided in nursing facilities.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/31/2026
- Legislative Related
- No
26-A-05-015.04We recommend that the Centers for Medicare & Medicaid Services instruct CMS contractors to increase claim reviews of optometrists' E/M services.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/31/2026
- Legislative Related
- No
26-A-05-015.05We recommend that the Centers for Medicare & Medicaid Services instruct CMS contractors to develop system edits to prevent the incorrect billing of E/M services.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/31/2026
- Legislative Related
- No
-
Four of Thirty Selected Dental Providers Did Not Comply With Terms and Conditions and Federal Requirements for Expending Provider Relief Fund Payments
26-A-02-014.01We recommend that HRSA require the selected dental providers to return to the Federal Government any PRF payments used to offset inaccurately calculated lost revenue amounts or properly account for these lost revenues.- Status
- Closed Implemented
- Responsible Agency
- HRSA
- Response
- Concur
- Potential Savings
- $3,381,110
- Last Update Received
- -
- Closed Date
- 01/09/2026
- Legislative Related
- No
-
Medicare Payments for Continuous Glucose Monitors and Supplies Exceeded Supplier Costs and Retail Market Prices, Indicating Medicare Can Save At Least Tens of Millions of Dollars in One Year
26-E-04-005.01CMS should pursue reductions to Medicare's payment rates for CGMs and supplies.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/19/2026
- Legislative Related
- No
26-E-04-005.02CMS should take action to prevent overpayments caused by suppliers' improper use of billing codes for CGMs and supplies to achieve potentially millions of dollars of cost savings for Medicare and enrollees.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $7,354,348
- Last Update Received
- -
- Next Update Expected
- 05/19/2026
- Legislative Related
- No
-
Gaps in NIH’s Oversight Put Millions in Funding for Other Transactions at Greater Risk of Fraud, Waste, or Abuse
26-E-04-006.01NIH should assess the benefits of Other Transactions to inform future Other Transaction policies and use.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/19/2026
- Legislative Related
- No
26-E-04-006.02NIH should strengthen justifications for using Other Transactions.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/19/2026
- Legislative Related
- No
26-E-04-006.03NIH should more effectively manage the unique risks of all Other Transactions.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/19/2026
- Legislative Related
- No
26-E-04-006.04NIH should establish internal controls to protect Other Transactions from mismanagement and fraud by both Other Transaction staff and recipients.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/19/2026
- Legislative Related
- No
-
Dermatology Providers Generally Met Medicare Requirements for Evaluation and Management Services Performed on Same Day as Minor Surgical Procedures
26-A-04-013.01We recommend that the Centers for Medicare & Medicaid Services work with the MACs and other CMS contractors to continue reviews of dermatologists' claims for E/M services performed on the same day as a minor surgical procedure, which could have resulted in an estimated cost savings of $62,915,655.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 02/27/2026
- Next Update Expected
- 09/05/2026
- Legislative Related
- No
26-A-04-013.02We recommend that the Centers for Medicare & Medicaid Services work with the MACs and other CMS contractors to continue to educate dermatologists on Medicare requirements for billing E/M services, including maintaining sufficient information to support that the E/M services were performed and billed at the appropriate service level and using modifier 25 appropriately when billing E/M services performed on the same day as a minor surgical procedure.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/17/2026
- Legislative Related
- No
-
CMS Put $11.2 Billion at Risk of Fraud, Waste, and Abuse by Not Properly Closing Contracts
26-A-04-012.01We recommend that the Centers for Medicare & Mediciad Services complete the administrative closeout requirements for the 12 contracts, totaling $2.1 billion, that remain overdue for closeout.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/16/2026
- Legislative Related
- No
26-A-04-012.02We recommend that the Centers for Medicare & Medicaid Services develop policies and procedures that clearly define documentation requirements, roles and responsibilities, and alternative procedures used so that contracts are closed timely.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 05/16/2026
- Legislative Related
- No
-
Nearly All Skilled Nursing Services Provided by Pinnacle Multicare Nursing and Rehabilitation Center Did Not Meet Medicare Payment Requirements
26-A-02-011.01We recommend that Pinnacle Multicare Nursing and Rehabilitation Center refund to the Medicare program $31,227,884 for skilled nursing services claims that did not meet Medicare requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $31,227,884
- Last Update Received
- 03/11/2026
- Next Update Expected
- 09/11/2026
- Legislative Related
- No
26-A-02-011.02We recommend that Pinnacle Multicare Nursing and Rehabilitation Center consider conducting one or more internal audits or investigations for claims before and after our audit period based on the risks identified by this audit to identify any similar overpayments the provider 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
- 03/11/2026
- Legislative Related
- No
26-A-02-011.03We recommend that Pinnacle Multicare Nursing and Rehabilitation Center provide additional training to its clinical and billing personnel on its procedures related to assigning appropriate billing codes when submitting claims for Medicare reimbursement; providing enrollees only reasonable and necessary skilled nursing services; and maintaining proper documentation to support services provided.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/11/2026
- Legislative Related
- No
-
Pennsylvania Correctly Invoiced Rebates to Manufacturers for Most Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations
26-A-03-009.01We recommend that the Pennsylvania Department of Human Services invoice for and collect from manufacturers rebates totaling $488,051 ($284,617 Federal share) for single-source and top-20 multiple-source physician-administered drugs and refund the Federal share of rebates collected.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $284,617
- Last Update Received
- 03/10/2026
- Next Update Expected
- 09/12/2026
- Legislative Related
- No
26-A-03-009.02We recommend that the Pennsylvania Department of Human Services continue to review exclusion reports and invoice manufacturers for rebate-eligible drugs dispensed after our audit period.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 03/10/2026
- Next Update Expected
- 09/12/2026
- Legislative Related
- No
26-A-03-009.03We recommend that the Pennsylvania Department of Human Services update its policies and procedures to require steps to regularly review exclusion reports for rebate eligible NDCs, and invoice for rebate those drugs identified as rebate eligible.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 03/10/2026
- Next Update Expected
- 09/12/2026
- Legislative Related
- No
-
Texas' Ambulance Services Supplemental Payment Program Did Not Comply With Federal and State Reimbursement Requirements
26-A-06-008.01We recommend that the Texas Department of Health and Human Services require training for all individuals that certify ASSPP cost reports on how to review cost reports for accuracy.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 03/05/2026
- Next Update Expected
- 09/05/2026
- Legislative Related
- No
26-A-06-008.02We recommend that the Texas Department of Health and Human Services revise its policies and procedures to require ambulance providers to submit sufficient documentation that allows the State agency to determine whether costs claimed on ASSPP cost reports are related to the provision of contracted patient care.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 03/05/2026
- Next Update Expected
- 09/05/2026
- Legislative Related
- No
-
South Carolina Did Not Comply With Federal Waiver and State Requirements at 19 of 20 Adult Day Care Facilities
26-A-04-007.01We recommend that the South Carolina Department of Health and Human Services work with the South Carolina Department of Public Health to ensure that providers correct the 204 instances of provider noncompliance identified in this report.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 02/23/2026
- Next Update Expected
- 08/27/2026
- Legislative Related
- No
26-A-04-007.02We recommend that the South Carolina Department of Health and Human Services improve its oversight and monitoring of providers.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 02/23/2026
- Next Update Expected
- 08/27/2026
- Legislative Related
- No
26-A-04-007.03We recommend that the South Carolina Department of Health and Human Services work with providers to improve their facilities, staffing, and training.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 02/23/2026
- Next Update Expected
- 08/27/2026
- Legislative Related
- No
-
Medicare Improperly Paid Suppliers $22.7 Million Over 7 Years for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided to Enrollees During Inpatient Stays
26-A-09-006.01We recommend that the Centers for Medicare & Medicaid Services direct the DME MACs to recover from suppliers up to $22,671,778 in identified improper payments for our audit period that are within the 4-year reopening period in accordance with CMS's policies and procedures.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $22,671,778
- Last Update Received
- -
- Next Update Expected
- 04/23/2026
- Legislative Related
- No
26-A-09-006.02We recommend that the Centers for Medicare & Medicaid services direct the DME MACs to recommend that the suppliers refund to enrollees up to $5,853,922 in deductible and coinsurance amounts that may have been incorrectly collected from them or from someone on their behalf.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2026
- Legislative Related
- No
26-A-09-006.03We recommend that the Centers for Medicare & Medicaid Services instruct the DME MACs to notify, as CMS deems appropriate, suppliers that received an overpayment or overpayments to consider conducting one or more internal audits or investigations based on the risks identified by this audit to identify any similar overpayments the supplier might have received and return any identified overpayments to the Medicare program.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2026
- Legislative Related
- No
26-A-09-006.04We recommend that the Centers for Medicare & Medicaid Services identify any DMEPOS claims after our audit period for items provided to enrollees during inpatient stays and direct the DME MACs to recover any improper payments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 03/03/2026
- Next Update Expected
- 09/03/2026
- Legislative Related
- No
26-A-09-006.05We recommend that the Centers for Medicare & Medicaid Services review system edits to determine whether any refinements are necessary to prevent improper payments to suppliers for DMEPOS items provided to enrollees during inpatient stays.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 04/23/2026
- Legislative Related
- No