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 January 15, 2026
1,189
Unimplemented
recommendations
3,163
Implemented and Closed
recommendations since FY 2017
Views
OIG Recommendations Grouped by Report
Showing 61–80 of 1,352 reports, containing 4,352 recommendations
Sorted by latest release date
-
CGS Administrators, LLC, Did Not Claim Some Allowable Medicare Excess Plan Costs Through Its Incurred Cost Proposals
25-A-07-091.01We recommend that CGS Administrators, LLC, work with CMS to ensure that its final settlement of contract costs reflects an increase in Medicare Excess Plan costs of $237,127 for CYs 2017 through 2021.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 02/11/2026
- Legislative Related
- No
-
CGS Administrators, LLC, Claimed Some Unallowable Medicare Supplemental Executive Retirement Plan III Costs Through Its Incurred Cost Proposals
25-A-07-092.01We recommend that CGS Administrators, LLC, work with CMS to ensure that its final settlement of contract costs reflects a decrease in Medicare SERP III costs of $1,913 for CYs 2017 through 2021.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $1,913
- Last Update Received
- -
- Next Update Expected
- 02/11/2026
- Legislative Related
- No
-
Alabama Did Not Always Verify Selected Nursing Homes’ Compliance With Background Check Requirements
25-A-04-093.01We recommend that the Alabama Department of Public Health develop a process for verifying that nursing homes complete a background check and a Registry query before employees begin work.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 02/11/2026
- Legislative Related
- No
25-A-04-093.02We recommend that the Alabama Department of Public Health educate nursing homes on the importance of conducting timely background checks and Registry queries.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 02/11/2026
- Legislative Related
- No
25-A-04-093.03We recommend that the Alabama Department of Public Health require nursing homes to develop policies and procedures to conduct Registry queries before employees begin work.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 02/11/2026
- Legislative Related
- No
25-A-04-093.04We recommend that the Alabama Department of Public Health conduct a review of nursing homes' compliance with background checks and Registry check requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 02/11/2026
- Legislative Related
- No
-
Florida Did Not Fully Comply With Federal Reporting and Oversight Requirements for Its Opioid Response Grant
25-A-04-089.01We recommend that the Florida Department of Children and Families (DCF) update the reconciliation process, or consider an alternative approach, so that Federal Financial Reports (FFRs) are submitted accurately and refunds of unspent funds are executed timely.- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 02/03/2026
- Legislative Related
- No
25-A-04-089.02We recommend that the Florida Department of Children and Families (DCF) require that a review of State Opioid Response (SOR) expenditures is included in DCF's desk reviews.- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 02/03/2026
- Legislative Related
- No
25-A-04-089.03We recommend that the Florida Department of Children and Families (DCF) require that Managing Entities (MEs) strengthen controls over service data entry and support maintained by network service providers.- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 02/03/2026
- Legislative Related
- No
25-A-04-089.04We recommend that the Florida Department of Children and Families (DCF) require Opioid Prevention Program-enrolled organizations to maintain supporting documentation for Federal grant activities reported and include information on reporting requirements and consequences for inaccurate or untimely reporting in future trainings.- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 02/03/2026
- Legislative Related
- No
25-A-04-089.05We recommend that the Florida Department of Children and Families (DCF) develop policies and procedures for maintaining data used to prepare progress reports for State Opioid Response (SOR) grants, including a standardized process for using data when reporting program goal outcomes.- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 02/03/2026
- Legislative Related
- No
-
Medicare Could Have Saved an Estimated $17.7 Million if CMS’s Oversight Had Prevented At-Risk Payments for Anesthesia Administered During Spinal Pain Management Procedures
25-A-09-087.01We recommend that the Centers for Medicare & Medicaid Services direct the MACs or other CMS contractors to review potentially improper claims for anesthesia administered during selected SPM procedures that had dates of service during our audit period to determine whether payments for administration of anesthesia complied with Medicare requirements.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/17/2025
- Legislative Related
- No
25-A-09-087.02We recommend that the Centers for Medicare & Medicaid Services collaborate with the MACs to develop or update system edits that would lower the risk of improper Medicare payments for anesthesia administered during selected SPM procedures, which could have saved an estimated $17,688,110 during our audit period.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $17,688,110
- Last Update Received
- -
- Next Update Expected
- 01/28/2026
- Legislative Related
- No
25-A-09-087.03We recommend that the Centers for Medicare & Medicaid Services collaborate with the MACs to develop additional physician education specific to anesthesia administered during selected SPM procedures, and consider the suggestions provided by the physicians for the 28 sessions in our nonstatistical sample.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/04/2025
- Next Update Expected
- 06/04/2026
- Legislative Related
- No
25-A-09-087.04We recommend that the Centers for Medicare & Medicaid Services share the results of this audit with all of the MACs to show that: (1) for the SPM procedures for which LCDs are in place, MACs paid physicians for anesthesia administered during selected SPM procedures that were at risk for noncompliance with Medicare requirements and (2) for sacroiliac joint injections for which two MACs do not have LCDs in place, these two MACs paid for almost half of the sessions nationwide in which anesthesia was administered during these procedures.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/28/2026
- Legislative Related
- No
-
CMS Should Take Additional Actions To Help Hospitals Prepare for a Future Emerging Infectious Disease Outbreak
25-A-02-086.01We recommend that the Centers for Medicare & Medicaid Services collaborate with its emergency preparedness partners to expand SSA surveyor training to include key planning areas related to emerging infectious diseases consistent with CMS interpretive guidelines.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/12/2025
- Next Update Expected
- 03/12/2026
- Legislative Related
- No
25-A-02-086.02We recommend that the Centers for Medicare & Medicaid Services require AO surveyor training to include key planning areas related to emerging infectious diseases comparable to those included for SSA surveyors.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/24/2026
- Legislative Related
- No
25-A-02-086.03We recommend that the Centers for Medicare & Medicaid Services, as part of CMS's accreditation review process, require AOs' hospital emergency preparedness standards to include addressing the needs of individuals from all at-risk patient populations.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/24/2026
- Legislative Related
- No
25-A-02-086.04We recommend that the Centers for Medicare & Medicaid Services require that AOs' hospital survey processes include verifying that hospital emergency plans address the needs of all at-risk patient populations.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/24/2026
- Legislative Related
- No
25-A-02-086.05We recommend that the Centers for Medicare & Medicaid Services encourage hospitals to take into consideration the mental health of hospital frontline staff as part of emergency preparedness planning.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/12/2025
- Next Update Expected
- 03/12/2026
- Legislative Related
- No
-
North Carolina Could Better Ensure That Intermediate Care Facilities for Individuals With Intellectual Disabilities Comply With Federal Requirements for Life Safety and Infection Control
25-A-04-085.01We recommend that the North Carolina Department of Health and Human Services verify that the three ICF/IIDs we inspected have taken corrective actions on the life safety and infection contol deficiencies identified during the audit.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/10/2025
- Legislative Related
- No
25-A-04-085.02We recommend that the North Carolina Department of Health and Human Services work with the applicable ICF/IID to determine whether mold exists.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/10/2025
- Legislative Related
- No
25-A-04-085.03We recommend that the North Carolina Department of Health and Human Services work with CMS to develop standardized life safety training for staff and ICF/IIDs.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/10/2025
- Legislative Related
- No
-
Hospitals Did Not Capture Half of Patient Harm Events, Limiting Information Needed to Make Care Safer
25-E-06-034.01CMS should work with Federal partners and other organizations to align harm event definitions and create a taxonomy of patient harm to drive a more comprehensive capture rate of harm events.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/12/2025
- Next Update Expected
- 10/08/2026
- Legislative Related
- No
25-E-06-034.02CMS should ensure that surveyors prioritize the Medicare QAPI requirement to hold hospitals accountable for patient harm.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/19/2025
- Legislative Related
- No
25-E-06-034.03CMS should instruct Quality Improvement Organizations to use information about harm events to assist hospitals in indentifying weaknesses in their incident reporting or other surveillance systems.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/12/2025
- Next Update Expected
- 10/08/2026
- Legislative Related
- No
25-E-06-034.04AHRQ should work with Federal partners and other organizations to align harm event definitions and create a taxonomy of patient harm to drive a more comprehensive capture rate of harm events.- Status
- Open Unimplemented
- Responsible Agency
- AHRQ
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/22/2026
- Legislative Related
- No
-
Pennsylvania Made More Than $8.7 Million in Unallowable Capitation Payments for Enrollees With Multiple Medicaid Identification Numbers
25-A-04-084.01We recommend that the Pennsylvania Department of Human Services refund to the Federal Government $4,596,390 in unallowable payments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $4,596,390
- Last Update Received
- -
- Next Update Expected
- 01/20/2026
- Legislative Related
- No
25-A-04-084.02We recommend that the Pennsylvania Department of Human Services review capitation payments subsequent to our audit period and refund any unallowable payments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/20/2026
- Legislative Related
- No
25-A-04-084.03We recommend that the Pennsylvania Department of Human Services use the Zero SSN report consistently and update it monthly, in accordance with the State agency's policy and procedures, to prevent the issuance of multiple Medicaid ID numbers for the same enrollee.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/20/2026
- Legislative Related
- No
25-A-04-084.04We recommend that the Pennsylvania Department of Human Services test the match-scoring algorithm to ensure it is working as intended.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/20/2026
- Legislative Related
- No
25-A-04-084.05We recommend that the Pennsylvania Department of Human Services enhance or establish new controls to prevent, detect, and correct instances where multiple Medicaid ID numbers are assigned to the same enrollee.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/20/2026
- Legislative Related
- No
-
Wisconsin Physicians Service Government Health Administrators Reopened and Corrected Cost Report Final Settlements for Desk Reviews Only With Obvious Errors To Correct Payments Made to Medicare Providers
25-A-06-083.01We recommend that Wisconsin Physicians Service Government Health Administrators develop and deliver additional education regarding applicable criteria and review requirements to auditors who perform desk reviews and supervisors who oversee the process.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/16/2026
- Legislative Related
- No
25-A-06-083.02We recommend that Wisconsin Physicians Service Government Health Administrators develop and implement enhanced procedures so that supervisors are better qualified to detect incorrect adjustments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/16/2026
- Legislative Related
- No
-
Kentucky Did Not Meet All of the Requirements for the COVID-19 Screening Testing Program at K-12 Schools
25-A-05-082.01We recommend that the Kentucky Department for Public Health develop or update ELC procedures for compliance with Federal and contract requirements, including managing the contract proposal review process; oversight of contracts to ensure compliance with monitoring background check documentation; and maintaining documentation to support expenditures.- Status
- Open Unimplemented
- Responsible Agency
- CDC
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/15/2026
- Legislative Related
- No
25-A-05-082.02We recommend that the Kentucky Department for Public Health work with CDC to determine the allowability of $4,569,390 in expenditures for COVID-19 testing services and refund to the Federal Government any unallowable amount.- Status
- Open Unimplemented
- Responsible Agency
- CDC
- Response
- Overdue
- Potential Savings
- $4,569,390
- Last Update Received
- -
- Next Update Expected
- 01/15/2026
- Legislative Related
- No
-
Oklahoma Could Better Ensure That Intermediate Care Facilities for Individuals With Intellectual Disabilities Comply With Federal Requirements for Life Safety, Emergency Preparedness, and Infection Control
25-A-06-080.01We recommended that the Oklahoma State Department of Health follow up with the 42 ICF/IIDs to verify that they have taken corrective actions on the life safety, emergency preparedness, and infection control deficiencies identified during the audit.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/14/2026
- Legislative Related
- No
25-A-06-080.02We recommended that the Oklahoma State Department of Health conduct surveys at ICF/IIDs at least every 15 months as required by CMS.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/14/2026
- Legislative Related
- No
25-A-06-080.03We recommended that the Oklahoma State Department of Health work with CMS to develop standardized life safety training for ICF/IID staff.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/14/2026
- Legislative Related
- No
-
Wisconsin Made at Least $18.5 Million in Improper Fee-For-Service Medicaid Payments for Applied Behavior Analysis Provided to Children Diagnosed With Autism
25-A-06-079.01We recommend that the Wisconsin Department of Health Services refund $12,287,252 (Federal share) to the Federal Government for FFS Medicaid ABA payments that did not comply with Federal and State requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $12,287,252
- Last Update Received
- 09/29/2025
- Next Update Expected
- 03/29/2026
- Legislative Related
- No
25-A-06-079.02We recommend that the Wisconsin Department of Health Services exercise reasonable diligence to review and determine whether any of the estimated $62,334,835 (Federal share) in potentially improper ABA payments complied with Federal and State requirements and refund the Federal share of any improper payment amount to the Federal Government- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/29/2025
- Next Update Expected
- 03/29/2026
- Legislative Related
- No
25-A-06-079.03We recommend that the Wisconsin Department of Health Services update guidance for CPT code 97155 to require documentation on how issues were resolved or what changes were made to the treatment protocol or POC.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/29/2025
- Next Update Expected
- 03/29/2026
- Legislative Related
- No
25-A-06-079.04We recommend that the Wisconsin Department of Health Services provide additional guidance to ABA facilities about how to document ABA, including the information needed in session notes to support ABA provided and billable ABA time, and State signature requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/29/2025
- Next Update Expected
- 03/29/2026
- Legislative Related
- No
25-A-06-079.05We recommend that the Wisconsin Department of Health Services develop a procedure to verify the provider who rendered the 97153-focused treatment service and pay the claim based on the rendering provider's specialty level.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/29/2025
- Next Update Expected
- 03/29/2026
- Legislative Related
- No
25-A-06-079.06We recommend that the Wisconsin Department of Health Services periodically conduct a statewide postpayment review of Medicaid ABA payments, including reviewing session notes, and provide training in areas where errors were identified by postpayment reviews.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/29/2025
- Next Update Expected
- 03/29/2026
- Legislative Related
- No
-
A Large Northeastern Hospital Could Improve Certain Security Controls for Preventing and Detecting Cyberattacks
25-A-18-077.01We recommend that the Entity enforce and periodically assess compliance with its configuration and change management policy, which requires that a security impact analysis be performed for all newly deployed or modified systems, including contractor-deployed systems, and that any discovered issues or unsecure configuration settings are resolved before a system is deployed or exposed to the internet.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/01/2026
- Legislative Related
- No
25-A-18-077.02We recommend that the Entity periodically assess and update its identification and authentication controls in its systems to ensure users are uniquely identified and authenticated; strong authentication and authenticators (e.g., passwords) have sufficient strength to prevent common cyberattacks against authentication controls (e.g., password spraying); and feedback of authentication information during the authentication process is not disclosed.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/01/2026
- Legislative Related
- No
25-A-18-077.03We recommend that the Entity periodically assess and update its configuration management controls in its systems to ensure information system flaws are identified and timely corrected; configuration settings for IT products on its systems are secure and in compliance with established configuration baselines; and systems functionality, including functions, ports, protocols, and services are limited to only those that are necessary.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/01/2026
- Legislative Related
- No
25-A-18-077.04We recommend that the Entity establish a policy or process to periodically assess its internet-accessible systems and applications security controls against security control standards from NIST SP 800-53 or similar industry web application security standards and promptly resolve any identified weaknesses.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/01/2026
- Legislative Related
- No
25-A-18-077.05We recommend that the Entity implement a policy that requires developers to follow secure coding practices for its web applications in accordance with the Entity's approved cybersecurity framework or industry web application security best practices for coding, testing, and maintaining web applications and establish a procedure to confirm adherence to the requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 01/01/2026
- Legislative Related
- No
-
Medicare Home Health Agency Provider Compliance Audit: HRS Home Health
25-A-05-076.01We recommend that HRS Home Health refund the $100,696 in estimated overpayments to the Medicare program.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $100,696
- Last Update Received
- 12/03/2025
- Next Update Expected
- 06/03/2026
- Legislative Related
- No
25-A-05-076.02We recommend that HRS Home Health consider conducting one or more internal audits or investigations for claims after our audit period based on the risks identified by this audit to identify any similar overpayments the provider might have received and return any identified overpayments to the Medicare program.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/03/2025
- Legislative Related
- No
25-A-05-076.03We recommend that HRS Home Health strengthen its review of medical record documentation to ensure compliance with Medicare billing requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/03/2025
- Legislative Related
- No
-
CMS Should Improve Its Methodology for Collecting Medicare Postoperative Visit Data on Global Surgeries
25-A-05-075.01We recommend that the Centers for Medicare & Medicaid Services educate practitioners and encourage the practitioners to educate the practices' staff on its data collection policy requirements for inpatient and outpatient settings and direct the MACs to educate individual practitioners on reporting requirements for postoperative visits after global surgeries.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 10/29/2025
- Next Update Expected
- 04/30/2026
- Legislative Related
- No
25-A-05-075.02We recommend that the Centers for Medicare & Medicaid Services establish detailed requirements for documenting postoperative visits provided in all settings in the medical records.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 12/25/2025
- Legislative Related
- No
25-A-05-075.03We recommend that the Centers for Medicare & Medicaid Services take one of the following steps to improve reporting of postoperative visits: establish and maintain a mechanism to identify practitioners that are required to report their postoperative visits and notify them of the reporting requirement; require all practitioners to report postoperative visits; or revise its requirements to clarify which practitioners are required to report.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 12/25/2025
- Legislative Related
- No
25-A-05-075.04We recommend that the Centers for Medicare & Medicaid Services improve its methodology for data collection to identify the relevant global surgery on postoperative visit claims and to obtain data on Medicare postoperative visits during hospital stays.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 12/25/2025
- Legislative Related
- No
25-A-05-075.05We recommend that the Centers for Medicare & Medicaid Services update its valuation of the global surgery fees to reflect the number of postoperative visits actually being provided to Medicare patients, which could have reduced payments for the global surgeries in our sampling frame by an estimated $5,723,292 for Medicare and an estimated $1,666,631 for Medicare patients.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- $5,723,292
- Last Update Received
- -
- Next Update Expected
- 12/25/2025
- Legislative Related
- No
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Michigan Did Not Effectively Monitor Home Heating Benefits Provided Under the Low-Income Home Energy Assistance Program
25-A-01-074.01We recommend that the Michigan Department of Health and Human Services take corrective action for the 17 improper payments in our sample of 90 HHC applications by refunding $26,763 to the Federal Government for the 15 HHC benefit overpayments.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Overdue
- Potential Savings
- $26,763
- Last Update Received
- -
- Next Update Expected
- 12/24/2025
- Legislative Related
- No
25-A-01-074.02We recommend that the Michigan Department of Health and Human Services take corrective action for the 17 improper payments in our sample of 90 HHC applications by paying $264 in additional HHC benefits to the 2 HHC applicants that received underpayments.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Overdue
- Potential Savings
- $264
- Last Update Received
- -
- Next Update Expected
- 12/24/2025
- Legislative Related
- No
25-A-01-074.03We recommend that the Michigan Department of Health and Human Services revise the interagency agreement to require MI Treasury to notify MI DHHS of any changes in procedures for processing HHC payments, including edits to the Bridge system.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 12/24/2025
- Legislative Related
- No
25-A-01-074.04We recommend that the Michigan Department of Health and Human Services determine the feasibility of reprocessing the approximately 118,000 HHC applications paid while the Bridge system edits were turned off, or work with OCS to develop a statistical sampling methodology to obtain information about the extent of payment errors that were made while the Bridge system edits were turned off and take appropriate action to correct them.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 12/24/2025
- Legislative Related
- No
25-A-01-074.05We recommend that the Michigan Department of Health and Human Services revise its Home Heating Credit Audit Process to incorporate a risk-based approach that includes high-risk HHC applications, such as those with high dollar payments and out-of-State mailing addresses, and require and maintain documentation to support findings identified and corrective actions taken during the monitoring process.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 12/24/2025
- Legislative Related
- No
25-A-01-074.06We recommend that the Michigan Department of Health and Human Services adhere to the interagency agreement's requirements and timeframes for quarterly monitoring.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 12/24/2025
- Legislative Related
- No
25-A-01-074.07We recommend that the Michigan Department of Health and Human Services test the HHC program data it receives from MI Treasury via the data warehouse to confirm that the data are complete and accurate before reporting HHC program information to ACF.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 12/24/2025
- Legislative Related
- No
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Maine Could Better Ensure That Intermediate Care Facilities for Individuals With Intellectual Disabilities Comply With Federal Requirements for Life Safety, Emergency Preparedness, and Infection Control
25-A-01-072.01We recommend that the Maine Department of Health and Human Services follow up with the 16 ICF/IIDs to verify that they have taken corrective actions on the life safety, emergency preparedness, and infection control deficiencies identified during the audit.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/22/2025
- Legislative Related
- No
25-A-01-072.02We recommend that the Maine Department of Health and Human Services conduct surveys at ICF/IIDs at least every 15 months as required by CMS.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/22/2025
- Legislative Related
- No
25-A-01-072.03We recommend that the Maine Department of Health and Human Services work with CMS to develop standardized life safety training for ICF/IID staff.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 10/03/2025
- Next Update Expected
- 04/22/2026
- Legislative Related
- No
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Eleven of Thirty Selected Hospitals Did Not Comply With Terms and Conditions and Federal Requirements for Expending Provider Relief Fund Payments
25-A-02-071.01We recommend that the Health Resources and Services Administration require the 10 hospitals that we determined as having used PRF payments for unallowable expenditures totaling $63 million to return the unallowable amounts to the Federal Government or ensure that the hospitals properly replace the unallowable expenditures with allowable unreimbursed lost revenues or eligible expenses, if any.- Status
- Open Unimplemented
- Responsible Agency
- HRSA
- Response
- Concur
- Potential Savings
- $63,037,416.58
- Last Update Received
- 11/26/2025
- Next Update Expected
- 06/08/2026
- Legislative Related
- No
25-A-02-071.02We recommend that the Health Resources and Services Administration require the 2 hospitals that we determined as having inaccurately calculated and reported lost revenues totaling $645.6 million to identify and return to the Federal Government any PRF payments used to offset inaccurately calculated lost revenues or replace them with allowable unreimbursed lost revenues or eligible expenses, if any.- Status
- Open Unimplemented
- Responsible Agency
- HRSA
- Response
- Concur
- Potential Savings
- $645,553,400.59
- Last Update Received
- 11/26/2025
- Next Update Expected
- 06/08/2026
- Legislative Related
- No
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Ten of Thirty Selected Nursing Facilities Did Not Comply or May Not Have Complied With Terms and Conditions and Federal Requirements for Expending Provider Relief Fund Payments
25-A-05-070.01We recommend that the Health Resources and Services Administration require the eight nursing facilities that we determined as having used PRF payments for unallowable expenditures and lost revenues totaling $2,256,504 to return the unallowable amounts to the Federal Government or ensure that the nursing facilities properly replace the unallowable expenditures and lost revenues with allowable unreimbursed lost revenues or eligible expenses, if any.- Status
- Open Unimplemented
- Responsible Agency
- HRSA
- Response
- Partial Concur
- Potential Savings
- $2,256,504
- Last Update Received
- 10/14/2025
- Next Update Expected
- 04/14/2026
- Legislative Related
- No
25-A-05-070.02We recommend that the Health Resources and Services Administration work with the three nursing facilities that we determined as having used PRF payments for potentially unallowable expenditures totaling $332,562 to identify and return the unallowable amounts to the Federal Government or ensure that the nursing facilities properly replace the unallowable expenditures with allowable unreimbursed lost revenues or eligible expenses, if any.- Status
- Open Unimplemented
- Responsible Agency
- HRSA
- Response
- Concur
- Potential Savings
- $332,562
- Last Update Received
- 10/14/2025
- Next Update Expected
- 04/14/2026
- Legislative Related
- No