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 December 17, 2025
1,189
Unimplemented
recommendations
3,163
Implemented and Closed
recommendations since FY 2017
Views
OIG Recommendations Grouped by Report
Showing 701–720 of 1,352 reports, containing 4,352 recommendations
Sorted by latest release date
-
Nebraska Claimed Unallowable School-Based Administrative Costs Because of Improper Coding of Random Moment Timestudy Responses
20-A-07-136.01We recommend that the Nebraska Department of Health and Human Services, Division of Medicaid and Long-Term Care refund $13,157,778 to the Federal Government.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $13,157,778
- Last Update Received
- 09/04/2025
- Next Update Expected
- 03/05/2026
- Legislative Related
- No
20-A-07-136.02We recommend that the Nebraska Department of Health and Human Services, Division of Medicaid and Long-Term Care review SBA costs claimed after our audit period and refund unallowable amounts.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/03/2022
- Legislative Related
- No
20-A-07-136.03We recommend that the Nebraska Department of Health and Human Services, Division of Medicaid and Long-Term Care strengthen oversight of its contractors to ensure that they follow the provisions of the NEBMAC Guide when assigning codes to the RMTS responses and when assigning participants to the RMTSs.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/03/2022
- Legislative Related
- No
-
Medicare Laboratory Test Expenditures Increased in 2018, Despite New Rate Reductions
20-E-09-033.01CMS should seek legislative authority to establish a mechanism to control costs for automated chemistry tests.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 06/23/2025
- Next Update Expected
- 07/01/2025
- Legislative Related
- Yes
-
Medicare Home Health Agency Provider Compliance Audit: Mission Home Health of San Diego, Inc.
20-A-09-135.01We recommend that Mission Home Health of San Diego, Inc. refund to the Medicare program the portion of the estimated $5,969,826 overpayment for claims incorrectly billed that are within the reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $5,969,826
- Last Update Received
- -
- Closed Date
- 02/11/2022
- Legislative Related
- No
20-A-09-135.02We recommend that Mission Home Health of San Diego, Inc. exercise reasonable diligence to identify and return overpayments in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation for the remaining portion of the estimated $5,969,826 overpayment for claims that are outside of the reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/11/2022
- Legislative Related
- No
20-A-09-135.03We recommend that Mission Home Health of San Diego, Inc., exercise reasonable diligence to identify and return any additional similar overpayments outside of our audit period, in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/11/2022
- Legislative Related
- No
20-A-09-135.04We recommend that Mission Home Health of San Diego, Inc., strengthen its procedures to ensure that the homebound statuses of Medicare beneficiaries are verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented; beneficiaries are receiving only reasonable and necessary skilled services; the correct HIPPS payment codes are billed; and documentation is maintained for beneficiaries' home health certifications and plans of care.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/11/2020
- Legislative Related
- No
-
Medicare Home Health Agency Provider Compliance Audit: Condado Home Care Program, Inc.
20-A-02-133.01We recommend that Condado Home Care Program, Inc. refund to the Medicare program the portion of the estimated $97,210 in overpayments for claims incorrectly billed that are within the 4-year claim reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $97,210
- Last Update Received
- -
- Closed Date
- 02/09/2021
- Legislative Related
- No
20-A-02-133.02We recommend that Condado Home Care Program, Inc., based upon 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.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/26/2021
- Legislative Related
- No
20-A-02-133.03We recommend that Condado Home Care Program, Inc., for the remaining portion of the estimated $97,210 in overpayments that are outside of the Medicare reopening period, exercise reasonable diligence to identify and return overpayments in accordance with the 60-day rule and identify any returned overpayments as having been made in accordance with this recommendation.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/26/2021
- Legislative Related
- No
20-A-02-133.04We recommend that Condado Home Care Program, Inc. strengthen its procedures to ensure that the homebound status of Medicare beneficiaries are verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented; beneficiaries are receiving only reasonable and necessary skilled services; home health episodes are billed correctly; and plans of care comply with Medicare requirements.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/09/2021
- Legislative Related
- No
-
Visionquest Industries, Inc.: Audit of Medicare Payments for Orthotic Braces
20-A-09-134.01We recommend that Visionquest Industries, Inc. refund to the DME MACs the portion of the $2,504,829 in estimated overpayments for claims that are within the 4-year reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $2,504,829
- Last Update Received
- -
- Closed Date
- 11/16/2024
- Legislative Related
- No
20-A-09-134.02We recommend that Visionquest Industries, Inc. exercise reasonable diligence to identify and return any additional similar overpayments in accordance with the 60-day rule,20 and identify any of those returned overpayments as having been made in accordance with this recommendation.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/04/2021
- Legislative Related
- No
20-A-09-134.03We recommend that Visionquest Industries, Inc. obtain as much information from beneficiary medical records as it determines necessary to assure itself that claims for orthotic braces meet Medicare requirements for medical necessity.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/07/2020
- Legislative Related
- No
-
Desoto Home Health Care, Inc.: Audit of Medicare Payments for Orthotic Braces
20-A-09-132.01We recommend that Desoto Home Health Care, Inc. refund to the DME MACs $2,878,544 in estimated overpayments for orthotic braces.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $2,878,544
- Last Update Received
- -
- Closed Date
- 11/17/2022
- Legislative Related
- No
20-A-09-132.02We recommend that Desoto Home Health Care, Inc. based upon the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule14 and identify any of those returned overpayments as having been made in accordance with this recommendation.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/08/2021
- Legislative Related
- No
20-A-09-132.03We recommend that Desoto Home Health Care, Inc. obtain as much information from beneficiary medical records as it determines necessary to assure itself that claims for orthotic braces meet Medicare requirements for medical necessity.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/08/2021
- Legislative Related
- No
-
Inadequate Edits and Oversight Caused Medicare To Overpay More Than $267 Million for Hospital Inpatient Claims With Post-Acute-Care Transfers to Home Health Services
20-A-04-131.01We recommended that CMS direct its Medicare contractors to recover the portion of the $722,288 in overpayments identified for the sample items in this audit that are within the 4-year reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $722,288
- Last Update Received
- -
- Closed Date
- 02/25/2022
- Legislative Related
- No
20-A-04-131.02We recommended that CMS direct its Medicare contractors to reprocess the remaining inpatient claims identified in our sample frame with an incorrect patient discharge status code when beneficiaries resumed home health services within 3 days of discharge and recover the portion of the estimated $218,538,919 in overpayments that are within the 4-year reopening period along with similarly coded inpatient claims after our audit period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $218,538,919
- Last Update Received
- -
- Closed Date
- 02/25/2022
- Legislative Related
- No
20-A-04-131.03We recommended that CMS direct its Medicare contractors to reprocess the remaining inpatient claims identified in our sample frame with a condition code 43 and recover the portion of the estimated $7,207,061 in overpayments that are within the 4-year reopening period along with similarly coded inpatient claims after our audit period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $7,207,061
- Last Update Received
- -
- Closed Date
- 02/25/2022
- Legislative Related
- No
20-A-04-131.04We recommended that CMS direct its Medicare contractors to analyze the remaining inpatient claims in our sample frame with a condition code 42, determine which claims were overpaid, and recover the portion of the estimated $40,610,333 in potential overpayments that are within the 4-year reopening period along with similarly coded inpatient claims paid after our audit period.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $40,610,333
- Last Update Received
- -
- Closed Date
- 05/25/2021
- Legislative Related
- No
20-A-04-131.05We recommended that CMS correct its CWF edits to ensure that the edits use the home health services on each line within a home health claim rather than only the first line, which will allow the edits to capture home health claims that overlap a hospital stay.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/29/2021
- Legislative Related
- No
20-A-04-131.06We recommended that CMS create CWF edits to prevent the use of condition code 43 from allowing the hospital to receive the full MS-DRG payment when the beneficiary receives home health services within 3 days of discharge.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/29/2021
- Legislative Related
- No
20-A-04-131.07We recommended that CMS educate providers regarding the proper use of patient discharge status codes, condition code 43, and condition code 42, particularly when beneficiaries resume home health services.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/01/2021
- Legislative Related
- No
20-A-04-131.08We recommended that CMS use data analytics to identify hospitals that disproportionately use condition code 42 when the diagnosis codes on the inpatient claim and the respective home health claim appear related.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/25/2021
- Legislative Related
- No
20-A-04-131.09We recommended that CMS consider reducing the need for clinical judgment when processing claims under the post-acute-care transfer policy by taking the necessary actions, including seeking legislative authority if necessary, to deem any home health service within 3 days of discharge to be “related” (which would have saved an estimated $46.6 million during our 2-year audit period).- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/11/2021
- Legislative Related
- Yes
-
Some Nursing Homes' Reported Staffing Levels in 2018 Raise Concerns; Consumer Transparency Could Be Increased
20-E-04-030.01CMS should enhance efforts to ensure nursing homes meet daily staffing requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/14/2022
- Legislative Related
- No
20-E-04-030.02CMS should explore ways to provide consumers with additional information on nursing homes' daily staffing levels and variability.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/14/2022
- Legislative Related
- No
-
North Carolina Did Not Ensure That Nursing Facilities Always Reported Allegations of Potential Abuse and Neglect of Medicaid Beneficiaries and Did Not Always Prioritize Allegations Timely
20-A-04-128.01We recommended that the State agency continue working with CMS to provide clear guidance to nursing facilities regarding what constitutes a reportable incident and when to report.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/08/2022
- Legislative Related
- No
20-A-04-128.02We recommended that the State agency revise its policies and procedures to require that it assign a priority level to incident reports even if the nursing facilities' investigations are not complete.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/08/2022
- Legislative Related
- No
20-A-04-128.03We recommended that the State agency revise its policies and procedures to require that it enter into ACTS the date that the State agency first receives incident reports.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/08/2022
- Legislative Related
- No
20-A-04-128.04We recommended that the State agency revise its policies and procedures to require that it manage employee absences to better prevent them from interfering with assigning priority levels to allegations within appropriate timeframes.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/04/2021
- Legislative Related
- No
20-A-04-128.05We recommended that the State agency integrate more fully the Personnel Investigations and Complaint Intake functions to ensure assignments of priority levels to incident reports occur within appropriate timeframes and to provide better oversight of nursing facilities that do not appropriately report required allegations.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/04/2021
- Legislative Related
- No
20-A-04-128.06We recommended that the State agency consider using ACTS to manage and record all operations associated with the complaint and incident report process.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/04/2021
- Legislative Related
- No
20-A-04-128.07We recommended that the State agency consider having Complaint Intake be the initial recipient of all incident reports from nursing facilities to assist in conducting more effective and timely investigations of all aspects of an allegation within incident reports.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/08/2022
- Legislative Related
- No
-
Kansas Did Not Ensure That Group Homes for Children in Foster Care Complied With All State Health and Safety Requirements
20-A-07-129.01We recommend that the Department for Children and Families follow up with all foster care group homes to verify that all of the maintenance deficiencies that we identified during the audit are corrected.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/19/2022
- Legislative Related
- No
20-A-07-129.02We recommend that the Department for Children and Families improve controls to ensure that foster care group homes are in compliance with State licensing requirements related to the health and safety of group home residents.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/19/2022
- Legislative Related
- No
20-A-07-129.03We recommend that the Department for Children and Families ensure that corrective action is taken when issues of noncompliance are found during the foster care group home inspection process- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/19/2022
- Legislative Related
- No
20-A-07-129.04We recommend that the Department for Children and Families improve controls over the background record check process to ensure that all individuals residing, working, or volunteering in the group homes submit all necessary background checks in a timely manner, and that proof of completion of the checks is retained.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/19/2022
- Legislative Related
- No
20-A-07-129.05The Department for Children and Families adequately monitor the foster care group homes to ensure that they are in compliance with the age and gender requirements of their State licensing agreements.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/19/2022
- Legislative Related
- No
-
The New York State Medicaid Agency Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths
20-A-04-127.01We recommend that the New York Department of Health refund $13,696,760 Federal share to the Federal Government.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $13,696,760
- Last Update Received
- -
- Closed Date
- 08/11/2023
- Legislative Related
- No
20-A-04-127.02We recommend that the New York Department of Health identify and recover unallowable payments made to MCOs during our audit period on behalf of deceased beneficiaries, which we estimated to be at least $23,325,502.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/28/2023
- Legislative Related
- No
20-A-04-127.03We recommend that the New York Department of Health identify and recover capitation payments made on behalf of deceased beneficiaries before and after our audit period, and repay the Federal share of amounts recovered.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/29/2025
- Legislative Related
- No
20-A-04-127.04We recommend that the New York Department of Health create system edits to help identify overpayments and failures in the automated interfaces between the eligibility, payment, and death data.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/06/2023
- Legislative Related
- No
20-A-04-127.05We recommend that the New York Department of Health use additional sources of date of death consistently to help reduce unallowable payments.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/29/2025
- Legislative Related
- No
-
New Jersey's Monitoring Did Not Ensure Child Care Provider Compliance With State Criminal Background Check Requirements at 9 of 30 Providers Reviewed
20-A-02-126.01We recommend that the New Jersey Department of Human Services conduct all required background checks for the 26 individuals we reviewed who did not have the required checks.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/19/2022
- Legislative Related
- No
20-A-02-126.02We recommend that the New Jersey Department of Human Services develop a system that provides notifications to State agency staff when criminal background checks need to be conducted for prospective and current employees and household members.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/26/2023
- Legislative Related
- No
20-A-02-126.03We recommend that the New Jersey Department of Human Services continue to work with ACF to reach substantial compliance with criminal background check requirements.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/22/2024
- Legislative Related
- No
-
CMS Could Have Saved $192 Million by Targeting Home Health Claims for Review With Visits Slightly Above the Threshold That Triggers a Higher Medicare Payment
20-A-09-125.01We recommend that the Centers for Medicare & Medicaid Services direct the MACs to recover the $41,613 in identified overpayments made to HHAs for the sampled claims.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $41,613
- Last Update Received
- -
- Closed Date
- 08/09/2021
- Legislative Related
- No
20-A-09-125.02We recommend that the Centers for Medicare & Medicaid Services require the MACs to perform data analysis and risk assessments of claims with visits slightly above the applicable LUPA threshold and target these claims for additional review.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/09/2021
- Legislative Related
- No
20-A-09-125.03We recommend that the Centers for Medicare & Medicaid Services instruct the MACs to educate HHA providers on properly billing for home health services with visits slightly above the applicable LUPA threshold, which could have saved Medicare as much as $191,773,995 during our audit period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $191,773,995
- Last Update Received
- -
- Closed Date
- 08/09/2021
- Legislative Related
- No
-
HRSA's Monitoring Did Not Always Ensure Health Centers' Compliance With Federal Requirements for HRSA's Access Increases In Mental Health and Substance Abuse Services Supplemental Grant Funding
20-A-02-121.01We recommend that the Health Resources and Services Administration assess health centers' progress toward meeting AIMS grant award conditions to increase personnel and patients' access to care and follow up with appropriate corrective action, such as providing technical assistance or discontinuing or reducing future AIMS grant funds.- Status
- Closed Implemented
- Responsible Agency
- HRSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/17/2021
- Legislative Related
- No
20-A-02-121.02We recommend that the Health Resources and Services Administration review BPRs to identify health centers that did not report progress toward meeting their health IT or training goals.- Status
- Closed Implemented
- Responsible Agency
- HRSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/17/2021
- Legislative Related
- No
20-A-02-121.03We recommend that the Health Resources and Services Administration ensure that it follows its policy for timely responding to health centers' requests to carry over grant funds.- Status
- Closed Implemented
- Responsible Agency
- HRSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/16/2021
- Legislative Related
- No
-
On-Site Psychological Services, P.C.: Audit of Medicare Payments for Psychotherapy Services
20-A-02-124.01We recommend that On-Site Psychological Services, P.C. refund to the Medicare program the estimated $3,373,440 overpayment.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $3,373,440
- Last Update Received
- -
- Closed Date
- 02/01/2024
- Legislative Related
- No
20-A-02-124.02We recommend that On-Site Psychological Services, P.C. based upon the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule25 and identify any of those returned overpayments as having been made in accordance with this recommendation.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/10/2023
- Legislative Related
- No
20-A-02-124.03We recommend that On-Site Psychological Services, P.C. strengthen its management oversight to ensure that it properly maintains treatment plans that contain all required elements, therapeutic maneuvers utilized by clinicians are properly documented in treatment notes, and it properly maintains reliable treatment notes to support services billed.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/09/2020
- Legislative Related
- No
20-A-02-124.04We recommend that On-Site Psychological Services, P.C. implement controls for authenticating signatures on treatment notes.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/09/2020
- Legislative Related
- No
-
Utah's Monitoring Process Generally Ensured Child Care Provider Compliance With State Criminal Background Check Requirements
20-A-07-122.01We recommend that the Utah Department of Health consider improving its policies and procedures for the monitoring of criminal background checks so that it routinely obtains wage information from DWS prior to the inspections of child care providers, so as to reduce the State agency's dependence on provider disclosure of prospective covered individuals.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/06/2023
- Legislative Related
- No
-
Alaska Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs
20-A-09-123.01Refund to the Federal Government $1,541,303 ($939,361 Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement;- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $939,361
- Last Update Received
- -
- Closed Date
- 12/11/2020
- Legislative Related
- No
20-A-09-123.02Refund to the Federal Government $115,712 ($73,892 Federal share) for claims for top 20 multiple-source physician-administered drugs that were ineligible for Federal reimbursement- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $73,892
- Last Update Received
- -
- Closed Date
- 12/11/2020
- Legislative Related
- No
20-A-09-123.03Work with CMS to determine the unallowable portion of $7,229 ($3,615 Federal share) for claims for other physician-administered drugs that were submitted with invalid NDCs and that may have been ineligible for Federal reimbursement and refund that amount.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $3,615
- Last Update Received
- -
- Closed Date
- 05/17/2021
- Legislative Related
- No
20-A-09-123.04Work with CMS to determine whether the remaining $300,266 ($185,066 Federal share) for claims for other physician-administered drugs could have been billed to the manufacturers to receive rebates and, if so, upon receipt of the rebates, refund the Federal share of the manufacturers' rebates for those claims.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $185,066
- Last Update Received
- -
- Closed Date
- 05/17/2021
- Legislative Related
- No
20-A-09-123.05Work with CMS to determine and refund the unallowable portion of Federal reimbursement for physician-administered drugs that were not billed for rebates after December 31, 2017.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/17/2021
- Legislative Related
- No
20-A-09-123.06Strengthen its internal controls to ensure that it bills manufacturers for rebates for all physician-administered drugs that are eligible for rebates.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/17/2021
- Legislative Related
- No
-
CMS Did Not Administer and Manage Strategic Communications Services Contracts in Accordance With Federal Requirements
20-A-12-120.01We recommend HHS determine whether any HHS contractors or subcontractors are performing inherently governmental functions and whether any active CMS service contracts or task orders are being administered as personal services contracts, and take action to correct their administration.- Status
- Closed Implemented
- Responsible Agency
- OS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/25/2024
- Legislative Related
- No
20-A-12-120.02We recommend HHS work with CMS's Office of the Administrator, in consultation with the HHS Office of Grants and Acquisition Policy and Accountability and the HHS Office of General Counsel, to improve contract management and ensure compliance with the FAR.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/09/2021
- Legislative Related
- No
20-A-12-120.03We recommend HHS provide training to political appointees and senior leaders related to proper contract administration.- Status
- Closed Implemented
- Responsible Agency
- OS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/07/2025
- Legislative Related
- No
20-A-12-120.04We recommend CMS provide training to program staff and contracting personnel, such as the contracting officers and CORs, on FAR requirements specifying that contracts must not be used for the performance of inherently governmental functions and related to written consent for the use of subcontractors.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/04/2022
- Legislative Related
- No
20-A-12-120.05We recommend CMS ensure that contracting personnel, such as the contracting officer, review contracts before they are awarded to determine whether they include language that could lead to those contracts being administered as personal services contracts.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/01/2022
- Legislative Related
- No
20-A-12-120.06We recommend CMS ensure that for all future contracts CMS receives and accepts deliverables in accordance with the SOW, CORs maintain working contract files, and CORs document all changes made to the SOW.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/04/2022
- Legislative Related
- No
20-A-12-120.07We recommend CMS review contractor costs incurred under TO 1 and TO 2 during the overlap of performance periods to determine whether duplicate payments were made and take appropriate action, as necessary.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/23/2020
- Legislative Related
- No
20-A-12-120.08We recommend CMS expand the “COR Invoice Approval Operating Guidance” to include a description of acceptable documentation to support contractor payments.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/01/2022
- Legislative Related
- No
20-A-12-120.09We recommend CMS review contractor invoices identified in this report that contained questionable costs, determine the allowability of those costs, and take appropriate action to recoup any improperly paid amounts.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/23/2020
- Legislative Related
- No
-
Ohio Did Not Ensure the Accuracy and Completeness of Psychotropic and Opioid Medication Information Recorded in Its Child Welfare Information System for Children in Foster Care
20-A-05-118.01We recommend that the Ohio Department of Job and Family Services improve monitoring to ensure that the county agencies maintain the required documentation in the Ohio SACWIS14 for the medications prescribed for children in its custody.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/29/2022
- Legislative Related
- No
20-A-05-118.02We recommend that the Ohio Department of Job and Family Services continue its efforts to obtain access to Medicaid claim data for children in its custody.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/29/2022
- Legislative Related
- No
20-A-05-118.03We recommend that the Ohio Department of Job and Family Services implement procedures for the monitoring of opioid medications prescribed for children in its custody.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/29/2022
- Legislative Related
- No
20-A-05-118.04We recommend that the Ohio Department of Job and Family Services review and update the medication list in the Ohio SACWIS on a regular schedule, at least once a year and as medications are approved or discontinued, to improve the reliability and relevancy of the list.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/29/2022
- Legislative Related
- No
20-A-05-118.05We recommend that the Ohio Department of Job and Family Services provide training and technical assistance to county agency workers who input medical and medication information into the Ohio SACWIS.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/29/2022
- Legislative Related
- No
-
Hospitals Overbilled Medicare $1 Billion by Incorrectly Assigning Severe Malnutrition Diagnosis Codes to Inpatient Hospital Claims
20-A-03-117.01We recommend that the Centers for Medicare & Medicaid Services collect the portion of the $914,128 for the incorrectly billed hospital claims that are within the reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $914,128
- Last Update Received
- -
- Closed Date
- 02/10/2021
- Legislative Related
- No
20-A-03-117.02We recommend that the Centers for Medicare & Medicaid Services notify appropriate providers (i.e., those for whom CMS determines this audit constitutes credible information of potential overpayments) so that the providers 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.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/10/2021
- Legislative Related
- No
20-A-03-117.03We recommend that the Centers for Medicare & Medicaid Services review the 224,175 inpatient claims in our sampling frame that were not part of our sample but were within the reopening period to identify which were incorrectly billed and recover identified overpayments.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $1,024,623,449
- Last Update Received
- -
- Closed Date
- 12/19/2022
- Legislative Related
- No
20-A-03-117.04We recommend that the Centers for Medicare & Medicaid Services review how hospitals are using diagnosis code E41 for nutritional marasmus and diagnosis code E43 for unspecified severe protein-calorie malnutrition and work with hospitals to ensure that they correctly bill Medicare when using severe malnutrition diagnosis codes.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/27/2023
- Legislative Related
- No