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 761–780 of 1,385 reports, containing 4,461 recommendations
Sorted by latest release date
-
New Jersey Did Not Ensure That Its Managed Care Organizations Adequately Assessed and Covered Medicaid Beneficiaries' Needs for Long-Term Services and Supports
20-A-02-110.01We recommend that the New Jersey Department of Human Services improve its monitoring and follow-up activities to ensure that its MCOs comply with Federal and State requirements detailed in its contracts with the MCOs for providing services to beneficiaries according to personalized care plans and actively coordinating, monitoring, and documenting beneficiaries' physical health, behavioral health, and long-term-care needs.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/13/2025
- Legislative Related
- No
20-A-02-110.02We recommend that the New Jersey Department of Human Services take actions, including imposing corrective action plans, fines, or other financial disincentives on MCOs, to address the MCOs' noncompliance affecting $721 million ($386 million Federal share) in capitation payments in CY 2016 and ensure future compliance with contract requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $385,867,495
- Last Update Received
- -
- Closed Date
- 03/13/2025
- Legislative Related
- No
-
The National Cancer Institute Needs To Strengthen Procedures in Its Pre-Award Process To Assess Risk for Higher Risk Applicants
20-A-03-111.01Update and strengthen written procedures for conducting and documenting applicant financial capability reviews as required by the GPAM and for determining how to manage risks identified by NCI Specialists- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/01/2021
- Legislative Related
- No
20-A-03-111.02Provide training to NCI Specialists about how to adequately document their evaluation of the financial capability of applicants.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/01/2021
- Legislative Related
- No
-
Medicare Hospital Provider Compliance Audit: The Ohio State University Hospital
20-A-05-107.01We recommend that The Ohio State University Hospital refund to the Medicare contractor $3,736,490 (of which $335,832 was net overpayments identified in our sample) in estimated overpayments for incorrectly billed services that are within the 4-year claim reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $3,736,490
- Last Update Received
- -
- Closed Date
- 12/22/2022
- Legislative Related
- No
20-A-05-107.02We recommend that The Ohio State University Hospital 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.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $90,398
- Last Update Received
- -
- Closed Date
- 06/10/2021
- Legislative Related
- No
20-A-05-107.03We recommend that The Ohio State University Hospital strengthen controls to ensure full compliance with Medicare requirements; specifically, ensure that all IRF beneficiaries meet Medicare criteria for acute inpatient rehabilitation; all inpatient beneficiaries meet Medicare criteria for inpatient hospital services; diagnosis and discharge status codes are supported in the medical records and staff are properly trained, and medical records accurately document the appropriate number of units and distinct procedural services and that staff are properly trained.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/13/2021
- Legislative Related
- No
-
The National Eye Institute Generally Had Adequate Procedures To Assess an Applicant's Risk During the Pre-Award Process
20-A-05-108.01We recommend that the National Institutes of Health direct the National Eye Institute to develop written procedures for conducting and documenting the financial capability review required by the HHS GPAM.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/07/2020
- Legislative Related
- No
20-A-05-108.02We recommend that the National Institutes of Health direct the National Eye Institute to provide training to NEI Specialists about how to adequately document their review of a grant applicant's financial statements and the organization's financial status.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/07/2020
- Legislative Related
- No
-
Medicare Part D Beneficiaries at Serious Risk of Opioid Misuse or Overdose: A Closer Look
20-E-02-020.01CMS should educate Part D beneficiaries about access to MAT drugs and naloxone.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/24/2022
- Legislative Related
- No
-
Medicare Made $11.7 Million in Overpayments for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient Stays
20-A-01-105.01We recommended that CMS ensure that all necessary information is included in the CWF edits to accurately identify and prevent incorrect payments for nonphysician outpatient services provided within 3 days before the date of admission, on the date of admission, or during IPPS stay.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/27/2020
- Legislative Related
- No
20-A-01-105.02We recommended that CMS direct the Medicare contractors to recover the portion of $11.7 million in identified overpayments (for claims within the 4-year reopening period) resulting from the 40,984 incorrectly billed services and instruct the outpatient providers to refund the portion of the $2,785,607 in deductible and coinsurance amounts (for claims within the 4-year reopening period) that may have been incorrectly collected from beneficiaries or from someone on their behalf.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $11,707,874
- Last Update Received
- -
- Closed Date
- 10/27/2020
- Legislative Related
- No
20-A-01-105.03We recommended that CMS direct the MACs to, based upon the results of this audit, notify the appropriate providers 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
- 10/27/2020
- Legislative Related
- No
20-A-01-105.04We recommended that CMS direct the MACs to educate outpatient providers on how to correctly bill nonphysician outpatient services provided within 3 days before the date of admission, on the date of admission, or during IPPS stays.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/04/2022
- Legislative Related
- No
-
Selected Health Care Coalitions Increased Involvement in Whole Community Preparedness But Face Developmental Challenges Following New Requirements in 2017
20-E-04-019.01ASPR should clarify HPP guidance that HCCs' membership should ensure strategic, comprehensive coverage of their communities' gaps in preparedness and response.- Status
- Closed Implemented
- Responsible Agency
- ASPR
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/23/2024
- Legislative Related
- No
20-E-04-019.02ASPR should continue to work with CMS to help health care entities comply with the CMS emergency preparedness CoPs.- Status
- Closed Implemented
- Responsible Agency
- ASPR
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/23/2024
- Legislative Related
- No
20-E-04-019.03ASPR should identify ways to incentivize core member participation in HCCs.- Status
- Closed Implemented
- Responsible Agency
- ASPR
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/23/2024
- Legislative Related
- No
20-E-04-019.04ASPR should clarify to HPP awardees the flexibility available in meeting Cooperative Agreement requirements.- Status
- Closed Implemented
- Responsible Agency
- ASPR
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/23/2024
- Legislative Related
- No
-
North Carolina Received $30 Million in Excess Federal Funds Related to Improperly Claimed Health Home Expenditures
20-A-04-102.01We recommend that the North Carolina Department of Health and Human Services, Division of Health Benefits reclassify $124,636,146 ($112,172,531 Federal share) from health home expenditures to PCCM expenditures.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/21/2020
- Legislative Related
- No
20-A-04-102.02We recommend that the North Carolina Department of Health and Human Services, Division of Health Benefits refund $30,649,113 in excess Federal funds to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $30,649,113
- Last Update Received
- -
- Closed Date
- 09/21/2020
- Legislative Related
- No
-
Illinois' Monitoring Did Not Ensure Childcare Provider Compliance With State Criminal Background Check Requirements at 12 of 30 Providers Reviewed
20-A-05-103.01We recommend that the Illinois Department of Human Services conduct all required criminal background checks for the 2 individuals we reviewed who did not have all required checks at the time of our data requests and site visits.- Status
- Closed Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/19/2022
- Legislative Related
- No
20-A-05-103.02We recommend that the Illinois Department of Human Services conduct all required criminal background checks for the 47 individuals we reviewed who did not have all recurring checks conducted within the last 5 years.- Status
- Closed Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/19/2022
- Legislative Related
- No
20-A-05-103.03We recommend that the Illinois Department of Human Services ensure that childcare providers notify the State when a new employee is hired or a new household member is added so that the State may conduct the required criminal background checks.- Status
- Closed Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/19/2022
- Legislative Related
- No
20-A-05-103.04We recommend that the Illinois Department of Human Services work with the State licensing agency to address staff and funding challenges to ensure that background checks are conducted on all licensed providers' employees or household members at least once every 5 years.- Status
- Closed Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/19/2022
- Legislative Related
- No
-
Office of Inspector General Penetration Test of the Centers for Medicare & Medicaid Services Affordable Care Act Information Systems
20-A-18-101.09Implement controls to identify and authenticate devices connecting to the CMS network.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 05/01/2024
- Next Update Expected
- 12/21/2024
- Legislative Related
- No
-
HHS Office of the Secretary Should Improve Preventative and Detective Controls to More Effectively Mitigate the Risk of Compromise
20-A-18-100.02Restrict users' ability (via permissions or application whitelisting) to install and run unauthorized software applications or commands on OS systems. Do not add users to the local administrator's group unless their job responsibilities require such elevated access.- Status
- Open Unimplemented
- Responsible Agency
- OS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 10/04/2023
- Next Update Expected
- 04/04/2024
- Legislative Related
- No
-
Grand Desert Psychiatric Services: Audit of Medicare Payments for Psychotherapy Services
20-A-09-099.01We recommend that Grand Desert Psychiatric Services refund to Noridian $421,272 in estimated overpayments for psychotherapy services.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $421,272
- Last Update Received
- -
- Closed Date
- 02/17/2022
- Legislative Related
- No
20-A-09-099.02We recommended that Grand Desert Psychiatric Services 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 Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/01/2022
- Legislative Related
- No
20-A-09-099.03We recommended that Grand Desert Psychiatric Services implement policies and procedures to ensure that psychotherapy services billed to Medicare are adequately documented, including the time spent on those services.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/10/2020
- Legislative Related
- No
20-A-09-099.04We recommended that Grand Desert Psychiatric Services strengthen management oversight and review Medicare claims to ensure that psychotherapy services billed to Medicare meet incident-to requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/10/2020
- Legislative Related
- No
20-A-09-099.05We recommended that Grand Desert Psychiatric Services improve its billing system to ensure that Medicare claims identify the correct provider of psychotherapy services.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/10/2020
- Legislative Related
- No
20-A-09-099.06We recommended that Grand Desert Psychiatric Services strengthen management oversight to ensure that psychotherapy services billed to Medicare were actually provided and have supporting documentation.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/10/2020
- Legislative Related
- No
-
Palmetto Government Benefits Administrator, LLC, Overstated Its Medicare Segment Pension Assets as of January 1, 2017
20-A-07-095.01We recommend that Palmetto Government Benefits Administrator, LLC decrease the Medicare segment pension assets by $2,126,821 and recognize $73,630,103 as the Medicare segment pension assets as of January 1, 2017.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/04/2020
- Legislative Related
- No
20-A-07-095.02We recommend that Palmetto Government Benefits Administrator, LLC establish policies and procedures to ensure compliance with Federal requirements and the pension segmentation language of the Medicare contracts.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/04/2020
- Legislative Related
- No
-
Companion Data Services, LLC, Overstated Its Medicare Segment Pension Assets as of January 1, 2017
20-A-07-096.01We recommend that Companion Data Services, LLC decrease the Medicare segment pension assets by $777,081 and recognize $17,276,454 as the Medicare segment pension assets as of January 1, 2017.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/04/2020
- Legislative Related
- No
20-A-07-096.02We recommend that Companion Data Services, LLC establish policies and procedures to ensure compliance with Federal requirements.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/04/2020
- Legislative Related
- No
-
Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Medicare Pension Costs
20-A-07-097.01We recommend that Palmetto Government Benefits Administrator, LLC, revise its FACP for FY 2012 to reduce its claimed Medicare pension costs by $42,054.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $42,054
- Last Update Received
- -
- Closed Date
- 11/04/2020
- Legislative Related
- No
-
Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs
20-A-07-098.01We recommend that Palmetto Government Benefits Administrator, LLC, revise its FACP for FY 2012 to decrease its Medicare PRB costs by $11,699.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $11,699
- Last Update Received
- -
- Closed Date
- 11/04/2020
- Legislative Related
- No
-
Cape Cod Child Development Program Did Not Meet Its Head Start Non-Federal Share Obligations
20-A-01-094.01We recommend that the Administration for Children and Families take steps through the bankruptcy process to recover $1,196,293 in Federal Head Start funds based on CCCDP's approximately $1,495,366 non-Federal share shortfall.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- $1,196,293
- Last Update Received
- -
- Closed Date
- 03/21/2023
- Legislative Related
- No
-
Recommendation Followup: Michigan Did Not Report and Refund the Full Federal Share of Medicaid Overpayments
20-A-05-093.01We recommend that the Michigan Department of Health and Human Services refund $1,217,800 of overpayments not reported on the Form CMS-64.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $1,217,800
- Last Update Received
- -
- Closed Date
- 02/07/2022
- Legislative Related
- No
20-A-05-093.02We recommend that the Michigan Department of Health and Human Services refund $46,370 for overpayments returned at the incorrect FMAP on the Form CMS-64.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $46,370
- Last Update Received
- -
- Closed Date
- 02/07/2022
- Legislative Related
- No
20-A-05-093.03We recommend that the Michigan Department of Health and Human Services refund $648,194 of overpayments not reported from the previous audit (A-05-09-00103) on the Form CMS-64.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/07/2022
- Legislative Related
- No
20-A-05-093.04We recommend that the Michigan Department of Health and Human Services follow its policies and procedures to ensure that overpayment collections are reported on the Form CMS-64 as prior period adjustments and at the FMAP in effect at the time the original overpayments were reported.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/07/2022
- Legislative Related
- No
-
Most Indian Health Service Purchased/Referred Care Program Claims Were Not Reviewed, Approved, and Paid in Accordance With Federal Requirements
20-A-03-091.01We recommend that the Indian Health Service establish an edit in the RCIS to enforce the requirement that each beneficiary submits documentation showing that he or she meets the geographic component of IHS's eligibility requirements.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/28/2022
- Legislative Related
- No
20-A-03-091.02We recommend that the Indian Health Service educate PRC Program staff about the importance of documenting their review of medical necessity and priority-level requirements.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/28/2022
- Legislative Related
- No
20-A-03-091.03We recommend that the Indian Health Service conduct outreach to beneficiaries and providers to ensure that they submit notifications of healthcare services within 72 hours (or 30 days for elderly and disabled beneficiaries).- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/28/2022
- Legislative Related
- No
20-A-03-091.04We recommend that the Indian Health Service pay for healthcare services only after receiving all required alternate resource documentation and resolving all information gaps.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/28/2022
- Legislative Related
- No
20-A-03-091.05We recommend that the Indian Health Service educate providers about informing beneficiaries that they must notify IHS if they have alternate resources that may cover health services.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/28/2022
- Legislative Related
- No
20-A-03-091.06We recommend that the Indian Health Service reeducate PRC Program staff about the importance of reviewing and responding to notifications of healthcare services on a timely basis.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/28/2022
- Legislative Related
- No
20-A-03-091.07We recommend that the Indian Health Service work with IHS's fiscal intermediary to ensure that the fiscal intermediary pays completed claim requests within 30 days of claim submission and work with providers to ensure that they submit accurate and complete claims in a timely manner.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/28/2022
- Legislative Related
- No
-
An Estimated 87 Percent of Inpatient Psychiatric Facility Claims With Outlier Payments Did Not Meet Medicare's Medical Necessity or Documentation Requirements
20-A-01-089.01We recommend that the Centers for Medicare & Medicaid Services increase the number of postpayment reviews of IPF claims to provide IPFs with more feedback on their compliance with Medicare requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/08/2021
- Legislative Related
- No
20-A-01-089.02We recommend that the Centers for Medicare & Medicaid Services research whether the physician certification and recertification requirements are useful in preventing inappropriate payments and if they are useful, continue to enforce them but if they are not useful, take the steps necessary to eliminate or amend those requirements.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/11/2021
- Legislative Related
- No
20-A-01-089.03We recommend that the Centers for Medicare & Medicaid Services, while the certification requirements remain in place, revise regulations or guidance to IPFs to require that physician certifications and recertifications be in a specific form, format, or language.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/18/2021
- Legislative Related
- No
20-A-01-089.04We recommend that the Centers for Medicare & Medicaid Services promulgate regulations to require that each IPF should have a policy compliant with State law to protect and promote the patient's right to make informed decisions that includes standards for documenting the patient's ability to make informed decisions.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/09/2023
- Legislative Related
- No
20-A-01-089.05We recommend that the Centers for Medicare & Medicaid Services conduct a study to determine whether outlier payments are being made only for cases with unusually high costs, and, if not, consider designing and testing alternatives to the current outlier payment methodology.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/28/2023
- Legislative Related
- No
20-A-01-089.06We recommend that the Centers for Medicare & Medicaid Services reassess the current CMS reimbursement policy for administrative necessary days that meet inpatient coverage requirements because the beneficiary has not met his or her discharge requirements to determine payment accuracy and effects on beneficiaries.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/18/2021
- Legislative Related
- No
20-A-01-089.07We recommend that the Centers for Medicare & Medicaid Services determine whether patient in-hospital fall rates should be added to the IPFQR program and whether CMS should require present-on-admission indicators on claims as an aid to tracking in-hospital falls.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/09/2023
- Legislative Related
- No