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 761–780 of 1,352 reports, containing 4,352 recommendations
Sorted by latest release date
-
Medicare Dialysis Services Provider Compliance Review: Bio-Medical Applications of Arecibo, Inc.
20-A-02-078.01We recommend that BMA refund to the Federal Government the portion of the estimated $96,185 in improper payments for claims incorrectly billed to the Medicare program that are within the reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $96,185
- Last Update Received
- -
- Closed Date
- 07/31/2020
- Legislative Related
- No
20-A-02-078.02We recommend that BMA for the remaining portion of the estimated $96,185 in improper payments for claims that are outside of the Medicare reopening period, exercise reasonable diligence to identify any additional similar improper payments 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
- 05/04/2023
- Legislative Related
- No
20-A-02-078.03We recommend that BMA 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
- 05/04/2023
- Legislative Related
- No
20-A-02-078.04We recommend that BMA strengthen its internal controls to ensure that plans of care and comprehensive assessments meet Medicare requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/20/2020
- Legislative Related
- No
20-A-02-078.05We recommend that BMA modify its internal controls to ensure that ESRD measurements are properly supported.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/20/2020
- Legislative Related
- No
20-A-02-078.06We recommend that BMA reinforce through training the application of its internal controls for physicians' orders and beneficiaries' medical records to ensure compliance with Medicare requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/20/2020
- Legislative Related
- No
-
Risk Assessment of HHS Grant Closeout Procedures
20-A-04-077.01We recommend that the U.S. Department of Health and Human Services, Assistant Secretary for Financial Resources work with PMS personnel to improve HHS OpDiv grant management offices' access to timely data.- Status
- Closed Implemented
- Responsible Agency
- OS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/22/2020
- Legislative Related
- No
20-A-04-077.02We recommend that the U.S. Department of Health and Human Services, Assistant Secretary for Financial Resources work with OpDivs and the PMS to ensure that OpDivs are trained in how to obtain and interpret the PMS reports available to them.- Status
- Closed Implemented
- Responsible Agency
- OS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/22/2020
- Legislative Related
- No
20-A-04-077.03We recommend that the U.S. Department of Health and Human Services, Assistant Secretary for Financial Resources continue the grant remediation process to close remaining pooled accounts in the PMS.- Status
- Open Unimplemented
- Responsible Agency
- OS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 11/21/2024
- Next Update Expected
- 05/22/2025
- Legislative Related
- No
20-A-04-077.04We recommend that the U.S. Department of Health and Human Services, Assistant Secretary for Financial Resources work with CMS to implement an electronic grant management system for CMCS and CCSQ; assign clear roles and responsibilities related to grant closeout activities at CMCS; and clarify CMCS's ability to close out its grants.- Status
- Open Unimplemented
- Responsible Agency
- OS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 11/21/2024
- Next Update Expected
- 05/22/2025
- Legislative Related
- No
20-A-04-077.05We recommend that the U.S. Department of Health and Human Services, Assistant Secretary for Financial Resources consider revising the HHS regulation at 45 CFR § 75.381 and the GPAM to align closeout time limits for OpDivs with those specified in 2 CFR § 200.343.- Status
- Closed Implemented
- Responsible Agency
- OS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/22/2020
- Legislative Related
- No
-
Most of the Non-Newly Eligible Beneficiaries for Whom Colorado Made Medicaid Payments Met Federal and State Requirements, but Documentation Supporting That All Eligibility Requirements Were Verified Properly Was Not Always in Place
20-A-07-076.01We recommend that the Colorado Department of Health Care Policy and Financing redetermine, as appropriate, the current Medicaid eligibility of the sampled beneficiaries who may not have met Federal and State eligibility requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/03/2021
- Legislative Related
- No
20-A-07-076.02We recommend that the Colorado Department of Health Care Policy and Financing ensure that all eligibility requirements, including those pertaining to resources, are properly verified during annual redeterminations for all non-newly eligible beneficiaries.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/03/2021
- Legislative Related
- No
20-A-07-076.03We recommend that the Colorado Department of Health Care Policy and Financing ensure that information is maintained in case files to support that eligibility determinations were performed in accordance with Federal and State requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/03/2021
- Legislative Related
- No
-
Florida Made Almost $4 Million in Unallowable Capitation Payments for Beneficiaries Assigned Multiple Medicaid ID Numbers
20-A-04-075.01We recommend that the Florida Agency for Health Care Administration refund to the Federal Government $3,909,840 (Federal share) in unallowable payments.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $3,909,840
- Last Update Received
- -
- Closed Date
- 10/02/2020
- Legislative Related
- No
20-A-04-075.02We recommend that the Florida Agency for Health Care Administration review capitation payments that fell outside of our audit period and refund any unallowable payments.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/03/2023
- Legislative Related
- No
20-A-04-075.03We recommend that the Florida Agency for Health Care Administration modify its current methodology to identify beneficiaries with multiple Medicaid identification numbers.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/02/2020
- Legislative Related
- No
-
Montana Medicaid Fraud Control Unit: 2019 Onsite Inspection
20-E-12-013.01Implement a comprehensive case management system that allows for efficient access to case documents and information.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/07/2025
- Legislative Related
- No
20-E-12-013.02Revise its policies and procedures manual to address the frequency of its periodic supervisory reviews.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/23/2020
- Legislative Related
- No
-
CMS Could Take Actions To Help States Comply With Federal Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions
20-A-09-074.01We recommend that CMS verify that all State plans comply with Federal requirements prohibiting payments for PPCs by reviewing all existing State plans to ensure that States' policies related to PPCs are defined.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 01/28/2025
- Next Update Expected
- 07/28/2025
- Legislative Related
- No
20-A-09-074.02We recommend that CMS issue a revised State plan preprint that contains all of the provisions identified in Federal requirements, if CMS continues to require States to use the preprint.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 01/28/2025
- Next Update Expected
- 07/28/2025
- Legislative Related
- No
20-A-09-074.03We recommend that CMS issue clarifying guidance to States to help ensure that they identify PPCs on inpatient claims from all inpatient hospitals.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 01/28/2025
- Next Update Expected
- 07/28/2025
- Legislative Related
- No
20-A-09-074.04We recommend that CMS issue clarifying guidance to States to help ensure that they correctly use the Medicare HAC list to identify PPCs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 01/28/2025
- Next Update Expected
- 07/28/2025
- Legislative Related
- No
20-A-09-074.05We recommend that CMS issue clarifying guidance to States to help ensure that they acquire from all inpatient hospital providers the information necessary to determine whether Medicare crossover claims contain PPCs and fully understand how to determine whether a crossover claim containing a PPC requires a payment adjustment.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 01/28/2025
- Next Update Expected
- 07/28/2025
- Legislative Related
- No
20-A-09-074.06We recommend that CMS issue clarifying guidance to States to help ensure that they understand how and when to apply the “reasonably isolate” language in 42 CFR § 447.26(c)(3)(ii) as it relates to the limitation of reduction in payment for PPCs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 01/28/2025
- Next Update Expected
- 07/28/2025
- Legislative Related
- No
20-A-09-074.07We recommend that CMS issue clarifying guidance to States to help ensure that they use all of the diagnosis codes that inpatient hospitals report to them to identify PPCs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 01/28/2025
- Next Update Expected
- 07/28/2025
- Legislative Related
- No
20-A-09-074.08We recommend that CMS make the necessary corrections to the FY 2016 Medicare HAC list.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/22/2020
- Legislative Related
- No
20-A-09-074.09We recommend that CMS work with States to ensure that their systems and processes for identifying PPCs use all diagnosis codes reported by inpatient hospitals.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 01/28/2025
- Next Update Expected
- 07/28/2025
- Legislative Related
- No
-
States' Use of Grant Funding for a Targeted Response to the Opioid Crisis
20-E-BL-012.01SAMHSA should work closely with States and territories during the no-cost extension period to address barriers to timely spending and to ensure that administrative cost caps are not exceeded.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/14/2021
- Legislative Related
- No
20-E-BL-012.02SAMHSA should require States that receive grants for OUD treatment to specifically report how many patients are receiving MAT.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/14/2021
- Legislative Related
- No
-
Missouri Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness
20-A-07-073.01We recommend that the Missouri Department of Health and Senior Services follow up with the 20 nursing homes to ensure that corrective actions have been taken regarding the life safety and emergency preparedness deficiencies identified in this report.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/10/2021
- Legislative Related
- No
20-A-07-073.02We recommend that the Missouri Department of Health and Senior Services work with CMS to develop standardized life safety training for nursing home staff.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/10/2021
- Legislative Related
- No
20-A-07-073.03We recommend that the Missouri Department of Health and Senior Services conduct more frequent surveys at nursing homes that have a history of multiple high-risk deficiencies and follow up to ensure that corrective actions have been taken.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/10/2021
- Legislative Related
- No
20-A-07-073.04We recommend that the Missouri Department of Health and Senior Services expand training of nursing home staffs with specific attention to the updating of emergency preparedness plan templates to address facility-specific preparations.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/10/2021
- Legislative Related
- No
-
Florida Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness
20-A-04-070.01We recommend that the Florida Agency for Health Care Administration follow up with the 20 nursing homes to ensure corrective actions have been taken regarding the life safety and emergency preparedness deficiencies identified in this report.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/12/2020
- Legislative Related
- No
20-A-04-070.02We recommend that the Florida Agency for Health Care Administration work with CMS to develop standardized life safety training for nursing home staff.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/12/2020
- Legislative Related
- No
20-A-04-070.03We recommend that the Florida Agency for Health Care Administration conduct more frequent surveys at nursing homes with a history of multiple high-risk deficiencies and follow up to ensure that corrective actions have been taken.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/12/2020
- Legislative Related
- No
20-A-04-070.04We recommend that the Florida Agency for Health Care Administration provide additional training to nursing homes to ensure that their State emergency plan is submitted and approved without delay.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/12/2020
- Legislative Related
- No
20-A-04-070.05We recommend that the Florida Agency for Health Care Administration continue to follow up with nursing homes to ensure that they implement their supplemental emergency plans.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/12/2020
- Legislative Related
- No
20-A-04-070.06We recommend that the Florida Agency for Health Care Administration work with county emergency management agencies to develop a process to monitor the submission and approval of State emergency plans and supplemental emergency plans.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/12/2020
- Legislative Related
- No
20-A-04-070.07We recommend that the Florida Agency for Health Care Administration expand State agency guidance to include all Federal emergency preparedness requirements in addition to the State emergency plan requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/12/2020
- Legislative Related
- No
20-A-04-070.08We recommend that the Florida Agency for Health Care Administration increase communication and collaboration with the county emergency management agencies to clarify roles and responsibilities; make them aware of pending, or newly licensed, nursing homes in their counties; identify areas where additional expertise may be needed to ensure that nursing homes meet CMS and State requirements and to ensure the safety of nursing home residents; and provide county emergency management agencies with survey results, to the extent possible, from individual nursing homes to identify specific vulnerabilities.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/12/2020
- Legislative Related
- No
-
SAMHSA's Oversight of Accreditation Bodies for Opioid Treatment Programs Did Not Comply With Some Federal Requirements
20-A-09-071.01We recommend that SAMHSA identify steps it can take and take action to ensure that it meets its goal for the number of OTPs it inspects each year.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/21/2020
- Legislative Related
- No
20-A-09-071.02We recommend that SAMHSA review the results of its inspections and take action to address accreditation bodies' noncompliance with survey requirements.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/21/2020
- Legislative Related
- No
20-A-09-071.03We recommend that SAMHSA ensure that its compliance officers follow the Compliance Audit Guidance by reviewing alternative patients' charts when parts of a chart are unavailable to determine an OTP's compliance with the Federal opioid treatment standards.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/21/2020
- Legislative Related
- No
20-A-09-071.04We recommend that SAMHSA work with the accreditation bodies to standardize the survey reports to include not only surveyor teams' information but also OTPs' compliance with each of the Federal opioid treatment standards.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/21/2020
- Legislative Related
- No
20-A-09-071.05We recommend that SAMHSA comply with Federal regulations and the HHS policy for documenting and retaining its evaluations of accreditation elements.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/21/2020
- Legislative Related
- No
-
Key Medicare Tools To Safeguard Against Pharmacy Fraud and Inappropriate Billing Do Not Apply to Part D
20-E-02-010.01CMS should allow revocation of Medicare enrollment for inappropriate billing of Part D.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 11/27/2023
- Next Update Expected
- 01/02/2025
- Legislative Related
- No
20-E-02-010.02CMS should include on the Preclusion List pharmacies that inappropriately bill Part D.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 11/09/2023
- Next Update Expected
- 01/02/2025
- Legislative Related
- No
20-E-02-010.03CMS should apply the Preclusion List payment prohibitions to pharmacies and other providers that dispense Part D drugs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 11/09/2023
- Next Update Expected
- 01/02/2025
- Legislative Related
- No
-
Communication and Management Challenges Impeded HHS's Response to the Zero-Tolerance Policy
20-E-BL-011.01HHS should take steps to ensure that children's interests are prioritized and represented in decisions affecting the UAC Program, both internally and when engaging with interagency partners.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/30/2023
- Legislative Related
- No
20-E-BL-011.02HHS should modify or pursue formal agreements with DHS and DOJ to ensure that it is receiving information that supports its operation of and ability to provide care for children in the UAC Program.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 11/19/2025
- Next Update Expected
- 12/04/2026
- Legislative Related
- No
20-E-BL-011.03HHS should improve communication to care provider facilities regarding interim guidance, operational directives, and other instructions that are not immediately available in published policy documents.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/25/2020
- Legislative Related
- No
20-E-BL-011.04HHS should further improve its ability to identify and track separated children by reducing reliance on manual processes.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/30/2023
- Legislative Related
- No
-
Medicare Hospital Provider Compliance Audit: Saint Francis Health Center
20-A-07-069.01We recommend that Saint Francis Health Center refund to the Medicare contractor $5,533,169 of the estimated overpayments for the claims incorrectly billed that are within the Medicare reopening period.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $5,533,169
- Last Update Received
- 10/09/2025
- Next Update Expected
- 04/09/2026
- Legislative Related
- No
20-A-07-069.02We recommend that Saint Francis Health Center for the remaining portion of the estimated $5,533,169 overpayment for claims 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
- 09/24/2024
- Legislative Related
- No
20-A-07-069.03We recommend that Saint Francis Health Center 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
- 09/24/2024
- Legislative Related
- No
20-A-07-069.04We recommend that Saint Francis Health Center strengthen controls to ensure full compliance with Medicare requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/29/2023
- Legislative Related
- No
-
The Centers for Medicare & Medicaid Services Did Not Identify and Report Potential Antideficiency Act Violations for 12 Contracts Used To Establish the Federal Marketplace Under the Affordable Care Act
20-A-03-068.01We recommend that the Centers for Medicare & Medicaid Services correct the bona fide needs obligation violations totaling $164,606,982 ($155,866,794 related to the Federal marketplace) and, if CMS is unable to correct those violations, report the Antideficiency Act violations.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $164,606,982
- Last Update Received
- -
- Closed Date
- 10/01/2023
- Legislative Related
- No
20-A-03-068.02We recommend that the Centers for Medicare & Medicaid Services correct the bona fide needs expenditure violations totaling $22,386,227 ($18,269,216 related to the Federal marketplace) and, if CMS is unable to correct those violations, report the Antideficiency Act violations.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $22,386,227
- Last Update Received
- -
- Closed Date
- 10/01/2023
- Legislative Related
- No
20-A-03-068.03We recommend that the Centers for Medicare & Medicaid Services coordinate with HHS, in consultation with the Office of the General Counsel, to develop guidance and train OFM personnel on the correct process to record obligations and expenditures to avoid potential Antideficiency Act violations.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/12/2022
- Legislative Related
- No
20-A-03-068.04We recommend that the Centers for Medicare & Medicaid Services develop automated controls in HIGLAS to ensure that contract expenditures for each program year are paid using appropriate program-year obligations.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/16/2023
- Legislative Related
- No
-
National Institutes of Health Had Information Technology Control Weaknesses Surrounding Its Electronic Health Record System
20-A-18-067.01Complete the NIST requirements for implementing an alternative processing site that is a reasonable and viable option. Identify, document, and implement actions to mitigate risks of using existing alternative site based on the risk assessment results until compliant alternate site is established.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/19/2020
- Legislative Related
- No
20-A-18-067.02Implement policies and procedures to ensure all software is upgraded or replaced prior to end of life.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/02/2020
- Legislative Related
- No
20-A-18-067.03Ensure that the automated CRIS User Account Management tool is operating as intended and confirm that all changes to user privileges are authorized, properly documented, and inactive accounts are deactivated.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/02/2020
- Legislative Related
- No
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CHI St. Vincent Infirmary: Audit of Outpatient Outlier Payments
20-A-06-066.01We recommend that CHI St. Vincent Infirmary return the $362,999 in improper outlier payments for the 70 claims that have been amended correctly.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $362,999
- Last Update Received
- -
- Closed Date
- 09/07/2023
- Legislative Related
- No
20-A-06-066.02We recommend that CHI St. Vincent Infirmary improve procedures and provide education to ensure claims billed to Medicare are accurate.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/29/2020
- Legislative Related
- No
20-A-06-066.03We recommend that CHI St. Vincent Infirmary amend the 33 claims (10 incorrectly amended and 23 not amended) to identify and return any improper outlier payments that are within the 4-year claims reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/07/2023
- Legislative Related
- No
20-A-06-066.04We recommend that CHI St. Vincent Infirmary for any of the 33 claims that are outside of the 4-year claims 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
- 08/24/2022
- Legislative Related
- No
20-A-06-066.05We recommend that CHI St. Vincent Infirmary exercise reasonable diligence to identify and return any additional similar overpayments (including overpayments received during our audit period for the remaining $1,072,249 in outlier payments that we did not review and 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
- 09/07/2023
- Legislative Related
- No
-
Ownership—But Not Physical Movement—of Selected Drugs Can Be Traced Through the Supply Chain
20-E-05-009.01FDA should follow up with the wholesale distributor that did not provide tracing information to OIG.- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/28/2020
- Legislative Related
- No
20-E-05-009.02FDA should provide educational outreach to trading partners about required drug product tracing information and data standardization guidelines.- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/05/2022
- Legislative Related
- No
20-E-05-009.03FDA should seek legislative authority to include information about a drug product's complete physical path through the supply chain on drug product tracing information.- Status
- Closed Acceptable Alternative
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/10/2023
- Legislative Related
- Yes
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New York Made Unallowable Payments Totaling More Than $10 Million for Managed Care Beneficiaries Assigned Multiple Medicaid Identification Numbers
20-A-02-065.01We recommend that the New York State Department of Health refund $11,257,368 to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $11,257,368
- Last Update Received
- -
- Closed Date
- 01/10/2025
- Legislative Related
- No
20-A-02-065.02We recommend that the New York State Department of Health identify and recover improper managed care payments made to different MCOs on behalf of beneficiaries with multiple Medicaid ID numbers prior to and after our audit period, and repay the Federal share of the amounts recovered.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/17/2023
- Legislative Related
- No
20-A-02-065.03We recommend that the New York State Department of Health strengthen its procedures for determining whether an individual applying for Medicaid has already been assigned a Medicaid ID number by ensuring that its system queries identify all individuals with existing Medicaid ID numbers and - local district and Marketplace staff follow guidance on identifying individuals with Medicaid ID numbers and use all available resources to identify and prevent the issuance of multiple Medicaid ID numbers to the same individual.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/31/2023
- Legislative Related
- No
-
New York Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs
20-A-02-063.01We recommend that the New York Department of Health refund to the Federal Government $3,197,404 (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
- $3,197,404
- Last Update Received
- -
- Closed Date
- 10/16/2024
- Legislative Related
- No
20-A-02-063.02We recommend that the New York Department of Health refund to the Federal Government $146,672 (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
- $146,672
- Last Update Received
- -
- Closed Date
- 10/16/2024
- Legislative Related
- No
20-A-02-063.03We recommended that the New York Department of Health work with CMS to determine the unallowable portion of $2,340,390 (Federal share) for other claims for covered outpatient physician-administered drugs that were submitted without NDCs and that may have been ineligible for Federal reimbursement and refund that amount, and whether the remaining $714,777 (Federal share) of other physician-administered drug claims could have been invoiced 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
- -
- Last Update Received
- -
- Closed Date
- 12/02/2024
- Legislative Related
- No
20-A-02-063.04We recommended that the New York Department of Health work with CMS to determine and refund the unallowable portion of Federal reimbursement for physician-administered drugs that were not invoiced for rebates after December 31, 2017.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/02/2024
- Legislative Related
- No
20-A-02-063.05We recommended that the New York Department of Health strengthen its internal controls to ensure that all physician-administered drugs eligible for rebates are invoiced.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/30/2023
- Legislative Related
- No
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New Mexico's Monitoring of Childcare Providers Generally Ensured Provider Compliance With State Criminal Background Check Requirements at 30 Childcare Providers Reviewed
20-A-06-064.01We recommend that New Mexico's Children, Youth, and Families Department ensure all required background checks are conducted for the 1 individual that did not have the required checks within the past 5 years at the time of our review.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/18/2022
- Legislative Related
- No
20-A-06-064.02We recommend that New Mexico's Children, Youth, and Families Department determine if the fingerprint system has the ability to notify BCU when fingerprints for childcare providers are submitted to DPS and if so implement this process.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/18/2022
- Legislative Related
- No
20-A-06-064.03We recommend that New Mexico's Children, Youth, and Families Department develop a process for BCU to notify The State Licensing Agency and the childcare provider when a background check is not completed due to lack of documentation or childcare staff member non-response.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/18/2022
- Legislative Related
- No
20-A-06-064.04We recommend that New Mexico's Children, Youth, and Families Department determine if the EPICS system can track and notify the child care provider one month before a childcare staff member's background check clearance expires and if so implement this process.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/18/2022
- Legislative Related
- No
20-A-06-064.05We recommend that New Mexico's Children, Youth, and Families Department implement name-based checks of the NCIC NSOR and complete checks on all childcare staff members.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/18/2022
- Legislative Related
- No