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 April 15, 2026
1,094
Unimplemented
recommendations
3,367
Implemented and Closed
recommendations since FY 2017
Views
OIG Recommendations Grouped by Report
Showing 721–740 of 1,385 reports, containing 4,461 recommendations
Sorted by latest release date
-
National Background Check Program for Long Term Care Providers: Assessment of State Programs Concluded in 2019
20-E-07-038.01CMS should assist participating States in addressing the challenge of coordination between State-level departments.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/14/2022
- Legislative Related
- No
20-E-07-038.02CMS should require that participating States consistently submit data that allow for CMS and each State to calculate determinations of ineligibility.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/30/2024
- Legislative Related
- No
-
Medicare Hospital Provider Compliance Audit: Flagstaff Medical Center
20-A-07-149.01We recommend that Flagstaff Medical Center refund to the Medicare contractor $79,216 in estimated overpayments for the audit period for claims that it incorrectly billed.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $79,216
- Last Update Received
- -
- Closed Date
- 01/05/2021
- Legislative Related
- No
20-A-07-149.02We recommend that Flagstaff Medical Center based on the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule,8 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
- 01/05/2021
- Legislative Related
- No
20-A-07-149.03We recommend that CMS strengthen controls to ensure full compliance with Medicare requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/05/2021
- Legislative Related
- No
-
Colorado Claimed Unsupported and Incorrect Federal Medicaid Reimbursement for Beneficiaries Enrolled in the New Adult Group
20-A-07-150.01We recommend that the Colorado Department of Health Care Policy and Financing update the CBMS by implementing an automatically accessible eligibility history that retains all beneficiary histories when retroactive changes occur, thereby eliminating the need for manual interventions to identify changes in eligibility status.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/18/2025
- Legislative Related
- No
20-A-07-150.02We recommend that the Colorado Department of Health Care Policy and Financing ensure that the MMIS retains all beneficiary eligibility changes and reconcile the beneficiaries' data contained in the MMIS to the data in the CBMS to determine whether discrepancies in Medicaid eligibility groups are occurring.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/20/2024
- Legislative Related
- No
20-A-07-150.03We recommend that the Colorado Department of Health Care Policy and Financing ensure that the CBMS has automated edits to enroll Transitional Medicaid beneficiaries in the correct eligibility group.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/23/2024
- Legislative Related
- No
-
Indiana's Monitoring Did Not Ensure Child Care Provider Compliance With State Criminal Background Check Requirements at 17 of 30 Providers Reviewed
20-A-05-148.01We recommend that the Indiana Family and Social Services Administration conduct all required criminal background checks for the 56 individuals we reviewed who did not have all required background checks at the time of our data requests and site visits.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Partial Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/06/2023
- Legislative Related
- No
20-A-05-148.02We recommend that the Indiana Family and Social Services Administration verify that the disqualified employee was terminated and not allowed onsite.- Status
- Closed Acceptable Alternative
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/06/2023
- Legislative Related
- No
20-A-05-148.03We recommend that the Indiana Family and Social Services Administration conduct the required criminal background checks on all new employees and new household members.- Status
- Closed Acceptable Alternative
- Responsible Agency
- ACF
- Response
- Partial Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/06/2023
- Legislative Related
- No
20-A-05-148.04We recommend that the Indiana Family and Social Services Administration develop a system that regularly notifies providers to initiate required background check procedures for all new employees and notifies providers when background check applications have not been received or fully processed.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Partial Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/06/2023
- Legislative Related
- No
-
Texas Relied on Impermissible Provider-Related Donations To Fund the State Share of the Medicaid Delivery System Reform Incentive Payment Program
20-A-06-147.01We recommend that the Texas Health and Human Services Commission refund $83,833,972 in Federal funds it inappropriately received because it used IGTs derived from impermissible provider-related donations to fund the State share of DSRIP Program payments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $83,833,972
- Last Update Received
- 04/02/2026
- Next Update Expected
- 10/02/2026
- Legislative Related
- No
20-A-06-147.02We recommend that the Texas Health and Human Services Commission provide its IGT entities with guidance about arrangements that may result in impermissible provider-related donations, such as those outlined in CMS's clarifying letter.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/02/2026
- Next Update Expected
- 10/02/2026
- Legislative Related
- No
20-A-06-147.03We recommend that the Texas Health and Human Services Commission request that its IGT entities disclose if similar arrangements exist and provide the State agency with action plans on ending the arrangements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/02/2026
- Next Update Expected
- 10/02/2026
- Legislative Related
- No
-
Michigan Did Not Bill Manufacturers for Some Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations
20-A-05-143.01We recommend that the Michigan Department of Health and Human Services bill for and collect manufacturers' rebates for pharmacy drugs and for single-source and top-20 multiple-source physician-administered drugs that we calculated to be at least $30,031,147 (Federal share) and refund the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $30,031,147
- Last Update Received
- -
- Closed Date
- 04/02/2026
- Legislative Related
- No
20-A-05-143.02We recommend that the Michigan Department of Health and Human Services work with CMS to determine whether the non-top-20 multiple-source physician-administered drugs and other physician-administered drugs without NDCs were eligible for rebates that we calculated to be at least $1,460,089 (Federal share) and, if so, upon receipt of the rebates, refund the Federal share of the rebates collected.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/02/2026
- Legislative Related
- No
20-A-05-143.03We recommend that the Michigan Department of Health and Human Services work with CMS to ensure that all pharmacy and physician-administered drugs eligible for rebates after our audit period are processed for rebates.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/09/2021
- Legislative Related
- No
20-A-05-143.04We recommend that the Michigan Department of Health and Human Services improve the processes for determining drug rebate eligibility to ensure that all rebate-eligible pharmacy and physician-administered drugs contained in the drug utilization data submitted by the MCOs are identified and billed for rebates.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/09/2021
- Legislative Related
- No
-
Medicare Contractors Were Not Consistent in How They Reviewed Extrapolated Overpayments in the Provider Appeals Process
20-A-05-144.01We recommend that the Centers for Medicare & Medicaid Services provide additional guidance to MACs and QICs to ensure reasonable consistency in procedures used to review extrapolated overpayments during the first two levels of the Medicare Parts A and B appeals process.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/12/2021
- Legislative Related
- No
20-A-05-144.02We recommend that the Centers for Medicare & Medicaid Services take steps to identify and resolve discrepancies in the procedures that MACs and QICs use to review extrapolations during the appeals process.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/12/2021
- Legislative Related
- No
20-A-05-144.03We recommend that the Centers for Medicare & Medicaid Services provide guidance to the program integrity contractors regarding the organization of extrapolation-related files that must be submitted in response to a provider appeal.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/26/2022
- Legislative Related
- No
20-A-05-144.04We recommend that the Centers for Medicare & Medicaid Services improve system controls to reduce the risk of MACs and QICs incorrectly marking the extrapolation flag field in the MAS.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/04/2021
- Legislative Related
- No
20-A-05-144.05We recommend that the Centers for Medicare & Medicaid Services update the information in the MAS to accurately reflect extrapolation amounts challenged as part of an appeal, whether the extrapolation was reviewed by a contractor, and the outcome of any extrapolation review.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/29/2023
- Legislative Related
- No
-
Illinois Claimed Unallowable Telemedicine Payments
20-A-05-145.01We recommend that the Illinois Department of Healthcare and Family Services refund $124,812 to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $124,812
- Last Update Received
- -
- Closed Date
- 02/08/2022
- Legislative Related
- No
20-A-05-145.02We recommend that the Illinois Department of Healthcare and Family Services give providers formal training on telemedicine billing requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/26/2022
- Legislative Related
- No
20-A-05-145.03We recommend that the Illinois Department of Healthcare and Family Services enhance the monitoring of provider compliance by conducting periodic reviews of telemedicine payments for compliance with billing requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/26/2022
- Legislative Related
- No
-
Indiana Paid $3.5 Million for Medicaid Nonemergency Medical Transport Claims That Did Not Comply With Federal and State Requirements
20-A-05-146.01We recommend that the State agency refund $3,485,563 to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $3,485,563
- Last Update Received
- -
- Closed Date
- 02/10/2022
- Legislative Related
- No
20-A-05-146.02We recommend that the State agency improve its oversight and monitoring of its Medicaid FFS NEMT program by requiring its broker to have procedures in place to ensure that NEMT services are adequately documented and the documentation is maintained according to Federal and State regulations.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/03/2021
- Legislative Related
- No
20-A-05-146.03We recommend that the State agency improve its oversight and monitoring of its Medicaid FFS NEMT program by requiring its broker to have procedures in place to ensure that transportation provider qualifications meet State requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/03/2021
- Legislative Related
- No
-
CMS's Encounter Data Lack Essential Information That Medicare Advantage Organizations Have the Ability to Collect
20-E-03-037.01CMS should require MAOs to submit the ordering provider NPI on encounter records for DMEPOS and for laboratory, imaging, and home health services.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 08/13/2025
- Next Update Expected
- 09/02/2026
- Legislative Related
- No
20-E-03-037.02CMS should establish and implement “reject edits” that (1) reject encounter records in which the ordering provider NPI is not present when required and (2) reject encounter records that contain an ordering provider NPI that is not a valid and active NPI in the NPPES registry.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 03/02/2021
- Next Update Expected
- 02/23/2021
- Legislative Related
- No
-
CMS Generally Met Requirements for the DMEPOS Competitive Bidding Program Round 1 Recompete
20-A-05-141.01We recommend that CMS follow its established Program procedures and applicable Federal requirements consistently in evaluating the financial documents of all suppliers.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/29/2023
- Legislative Related
- No
20-A-05-141.02We recommend that CMS ensure that suppliers have the applicable licenses for the specific competitions in which they are submitting a bid by continuing to work with State licensing boards, as recommended in our previous report.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/04/2026
- Legislative Related
- No
20-A-05-141.03We recommend that CMS ensure that it has a system to monitor supplier licensure requirements and identify potentially unlicensed suppliers.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/30/2025
- Legislative Related
- No
-
New Jersey Did Not Ensure That Incidents of Potential Abuse or Neglect of Medicaid Beneficiaries Residing in Nursing Facilities Were Always Properly Investigated and Reported
20-A-02-140.01We recommend that the New Jersey Department of Human Services (NJDHS) work with the New Jersey Department of Health to reinforce guidance to nursing facilities for ensuring potential incidents of abuse or neglect are reported in accordance with Federal and State requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/18/2020
- Next Update Expected
- 08/19/2022
- Legislative Related
- No
20-A-02-140.02We recommend that the New Jersey Department of Human Services work with the New Jersey Department of Health to develop additional procedures for its survey site visits, including reviewing nursing facilities' records related to hospital transfers for certain beneficiary injuries or conditions that could be the result of potential abuse or neglect.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/18/2020
- Next Update Expected
- 08/19/2022
- Legislative Related
- No
-
Rhode Island's Monitoring Did Not Ensure Child Care Provider Compliance With State Criminal Background Check Requirements at 18 of 30 Providers Reviewed
20-A-01-137.01We recommend that the Rhode Island Department of Human Services conduct or renew all required criminal background checks for the 108 individuals we reviewed who did not have all required checks or who had expired background checks at the time of our data request and site visits.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/13/2021
- Legislative Related
- No
20-A-01-137.02We recommend that the Rhode Island Department of Human Services determine whether it is feasible to develop a centralized process to monitor both family homes and childcare centers.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/13/2021
- Legislative Related
- No
20-A-01-137.03We recommend that the Rhode Island Department of Human Services determine whether it is feasible to increase the ratio of State licensing inspectors to child care providers to meet industry standards so that it can review all employee criminal background checks at all child care providers.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/13/2021
- Legislative Related
- No
20-A-01-137.04We recommend that the Rhode Island Department of Human Services require the State licensing agency to increase the number of current employees it reviews at all child care centers to ensure child care provider compliance with criminal background check requirements.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/13/2021
- Legislative Related
- No
-
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
- 04/02/2026
- Next Update Expected
- 10/02/2026
- 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