Recommendations Tracker

We recommend that the Centers for Medicare & Medicaid Services maintain its efforts to improve the integrity of the Medicaid program by continuing to provide training, technical advice, and guidance to States to address the causes identified in OIG's prior audits in order to ensure that States improve the accuracy of eligibility caseworkers who manually input case actions and verify eligibility requirements; improve their eligibility verification systems to properly verify all eligibility information in a timely manner; and develop additional policies and procedures to produce more accurate eligibility determinations and to resolve eligibility discrepancies in a timely manner.

ASFR should improve the case management and tracking of referrals.

ASFR should conduct outreach and provide additional training about the suspension and debarment program to HHS awarding agencies that make few or no referrals.

CMS should establish guidelines for progressive enforcement actions, including the use of sanctions, when persistent or egregious performance problems emerge.

CMS should disseminate results of State performance reviews more widely to ensure that stakeholders become aware of problems.

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

We recommend that Healthfirst Health Plan, Inc. continue its examination of existing compliance procedures to identify areas where improvements can be made to ensure that diagnosis codes 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.

We recommended that Noridian Healthcare Solutions, LLC, increase Medicare's share of the Medicare segment excess pension assets as of December 31, 2016, by $2,261,097 and recognize $703,387 as Medicare's share of the pension assets as a result of the benefit curtailment.

We recommend that the Louisiana Department of Education develop a process to ensure providers initiate required background checks for all employees in a timely manner.

We recommend that the Arkansas Department of Human Services follow waiver guidance for incidents that appear to be abuse that require review and followup.

We recommend that the Arkansas Department of Human Services consider amending critical incident reporting requirements, including those related to incidents of death, to clearly apply to circumstances in which State agency employees or contractors are providing waiver services at a non-State facility or a private home, and a critical incident occurs.

Based on the results of this audit, 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 recommend that the FDA automate both the tracking of awards assigned to contract closeout staff for closeout and the process of sending closeout documents to the contractor and COR.

We recommend that the FDA require contracting officers and CORs to notify contract closeout specialists in a timely manner when a contract is physically complete.

FDA work with the Program Support Center to obtain from PRISM recurring reports used to facilitate contract closeout.

CMS should take steps to increase the number of providers and opioid treatment programs for Medicare beneficiaries with opioid use disorder.

CMS should take steps to increase the utilization of behavioral therapy among beneficiaries receiving medication to treat opioid use disorder.

CMS should collect data on the use of telehealth in opioid treatment programs.

We recommend that the Centers for Medicare & Medicaid Services instruct the MACs to, based upon the results of this audit, notify appropriate physicians (i.e., those for whom CMS determines this audit constitutes credible information of potential overpayments) 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 recommend that the Centers for Medicare & Medicaid Services assess the effectiveness of oversight mechanisms specific to preventing or detecting improper payments to physicians for more than the allowed number of facet joints per denervation session to determine why the MACs allowed more than the MUE values that were applicable during our audit period, and modify the oversight mechanisms based on that assessment.

We recommend that the Centers for Medicare & Medicaid Services direct the MACs to review claims for facet-joint denervation sessions after our audit period to identify instances in which Medicare paid physicians for facet joints that exceeded the number of allowable facet joints per session (in accordance with the applicable LCDs) and recover any improper payments identified.

We recommend that the Kentucky Cabinet for Health and Family Services review capitation payments that fell outside of our audit period and refund any unallowable payments.

CMS should assess the effectiveness of its enforcement of inappropriate facility-initiated discharges.

ACL should assist State Ombudsman programs in establishing a data-collection system for facility-initiated discharge notices.

ACL and CMS should coordinate to strengthen safeguards to protect nursing home residents from inappropriate facility-initiated discharges.

ACL and CMS should coordinate to strengthen safeguards to protect nursing home residents from inappropriate facility-initiated discharges.

We recommend that the Office of Intergovernmental and External Affairs establish an oversight program that includes approving officials reviewing and signing travel authorizations and vouchers only after verifying that the types of expenses claimed are authorized and allowable, the amounts claimed are accurate, and the required receipts are attached to the voucher; Program Coordinators verifying that all cardholders take the initial IBA card training course; and Program Coordinators regularly using the online reporting capabilities provided by the servicing bank to monitor for potential travel card misuse and delinquency trends.