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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—a subset that we think, if implemented, would have the most impact (learn more). Notable differences from our previous Top Unimplemented Recommendations report include:
- The list is comprised of individual recommendations from OIG reports, not rolled up by topic.
- No arbitrary cap is imposed on the number of recommendations included.
- Status updates as recommendations are implemented.
Summary of All Recommendations
Updated Monthly · Last updated on November 15, 2024
1,310
Unimplemented
recommendations
$27.0B
Potential savingsfrom unimplemented recommendations
2,698
Implemented and Closed
recommendations since FY 2017
Views
OIG Recommendations Grouped by Report
Showing 841–860 of 1,223 reports, containing 4,008 recommendations
Sorted by latest release date
-
New York May Have Improperly Claimed Medicaid Reimbursement for Certain Dental Services
19-A-02-026.01We recommend that the State agency investigate each potentially improper dental fee-for-service claim and refund up to $33,996 to the Federal Government, as appropriate.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $33,996
- Last Update Received
- -
- Closed Date
- 02/25/2020
- Legislative Related
- No
19-A-02-026.02We recommend that the State agency revise the MMIS system edit to ensure that fee-for-service dental claims are not reimbursed for beneficiaries residing in nursing facilities and residential treatment centers.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/23/2018
- Legislative Related
- No
19-A-02-026.03We recommend that the State agency amend the NYCRR and State agency program guidelines to prohibit the separate Medicaid reimbursement of clinic dental claims, which may have saved as much as $635,011 during our audit period, for services provided to beneficiaries who reside in nursing facilities and residential treatment centers.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $635,011
- Last Update Received
- -
- Closed Date
- 11/23/2018
- Legislative Related
- No
-
Significant Vulnerabilities Exist in the Hospital Wage Index System for Medicare Payments
19-A-01-025.01We recommend that CMS and the Secretary revisit the plan to comprehensively reform the hospital wage index system, including the previously researched option of a commuting-based wage index.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/20/2023
- Legislative Related
- Yes
19-A-01-025.02We recommend that CMS seek legislative authority to penalize hospitals that submit inaccurate or incomplete wage data in the absence of misrepresentation or falsification.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/20/2023
- Legislative Related
- Yes
19-A-01-025.03We recommend that, if there is no movement toward comprehensive reform, CMS work with the MACs to develop a program of in-depth wage data audits at a limited number of hospitals each year, focusing on hospitals whose wage data has a high level of influence on the wage index of their area.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/14/2023
- Legislative Related
- No
19-A-01-025.04We recommend that CMS seek legislation to repeal the law creating the rural floor wage index.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/20/2023
- Legislative Related
- Yes
19-A-01-025.05We recommend that CMS seek legislation to repeal the hold-harmless provisions in the Act relating to the wage data of reclassifying hospitals, which would allow CMS to calculate each area wage index based on the wage data of hospitals that reclassify into the area and the wage data of hospitals geographically located in the area if they do not reclassify out.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/20/2023
- Legislative Related
- Yes
19-A-01-025.06We recommend that CMS rescind its own hold-harmless policy to use the wage data of a reclassified hospital to calculate the wage index of its original geographic area.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/14/2023
- Legislative Related
- No
-
Payments Made by Novitas Solutions, Inc., to Hospitals for Certain Advanced Radiation Therapy Services Did Not Fully Comply With Medicare Requirements
19-A-02-023.01Recover from hospitals the portion of the estimated $7,230,420 in identified improper payments for claims incorrectly billed that are within the reopening period.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $7,230,420
- Last Update Received
- -
- Closed Date
- 11/12/2020
- Legislative Related
- No
19-A-02-023.02Notify the hospitals responsible for the remaining portion of the estimated $7,230,420 in potential overpayments for claims that are outside of the Medicare reopening period, so that those hospitals can investigate and return any identified overpayments in accordance with the 60-day rule and track any returned overpayments- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/12/2020
- Legislative Related
- No
19-A-02-023.03Identify and recover any additional similar overpayments for IMRT services made after the audit period.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/12/2020
- Legislative Related
- No
19-A-02-023.04Work with CMS to implement edits that would prevent separate payments for individual IMRT services included in the bundled payment for IMRT planning- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/07/2019
- Legislative Related
- No
19-A-02-023.05Educate hospitals on properly billing Medicare for IMRT planning services.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/07/2019
- Legislative Related
- No
-
Although Hospital Tax Programs in Seven States Complied With Hold-Harmless Requirements, the Tax Burden on Hospitals Was Significantly Mitigated
19-A-03-022.01We recommend that CMS re-evaluate the effects of the health-care-related tax safe-harbor threshold and the associated 75/75 requirement to determine if modifications are needed, such as the reduction or elimination of the safe harbor threshold or adjusting the 75/75 requirement, and take appropriate action.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 01/29/2024
- Next Update Expected
- 07/30/2024
- Legislative Related
- No
-
National Government Services, Inc., Understated Its Plan A Medicare Segment Pension Assets
19-A-07-018.01We recommend that NGS increase Plan A Medicare segment assets by $21,152 and recognize $8,778,177 as the plan A Medicare segment pension assets as of January 1, 2015.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $21,152
- Last Update Received
- -
- Closed Date
- 06/18/2019
- Legislative Related
- No
19-A-07-018.02We recommend that NGS develop quality assurance procedures to ensure that going forward, it calculates Medicare segment pension assets in accordance with Federal requirements.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/18/2019
- Legislative Related
- No
-
National Government Services, Inc., Claimed Some Unallowable Medicare Pension Costs
19-A-07-019.01We recommend that NGS revise its FACPs for FYs 2010 through 2013 to reduce its claimed Medicare pension costs by $763,067.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $763,067
- Last Update Received
- -
- Closed Date
- 03/03/2022
- Legislative Related
- No
-
National Government Services, Inc., Did Not Claim Some Allowable Medicare Postretirement Benefit Costs
19-A-07-021.01We recommend that NGS revise its FACPs for FYs 2010 through 2013 to increase its claimed Medicare PRB costs by $1,148,536.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/03/2022
- Legislative Related
- No
-
Northwestern University Did Not Always Comply With Federal Requirements To Perform Risk Assessments of Subrecipients, but Claimed Allowable Costs
19-A-05-016.01We recommend that Northwestern establish policies to perform subrecipient risk assessments for affiliates, FDP members, and non-Federal subrecipients subject to 45 CFR part 75.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/10/2024
- Legislative Related
- No
19-A-05-016.02We recommend that Northwestern ensure that subrecipient risk assessments are performed on all non-Federal subrecipients subject to 45 CFR part 75.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/10/2024
- Legislative Related
- No
-
CMS Did Not Always Ensure Hospitals Complied With Medicare Reimbursement Requirements for Graduate Medical Education
19-A-02-015.01We recommend that CMS take steps to ensure that no resident is counted as more than one FTE. This could include implementing procedures to analyze MACs' IRIS data or requiring MACs to determine if residents claimed by hospitals in their jurisdiction were claimed as more than one FTE.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/19/2018
- Legislative Related
- No
-
The Food and Drug Administration's Policies and Procedures Should Better Address Postmarket Cybersecurity Risk to Medical Devices
19-A-18-013.01We recommend that FDA continually assess the cybersecurity risks to medical devices and update, as appropriate, its plans and strategies.- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/29/2018
- Legislative Related
- No
19-A-18-013.02We recommend that FDA establish written procedures and practices for securely sharing sensitive information about cybersecurity events with key stakeholders who have a “need to know.”- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/20/2021
- Legislative Related
- No
19-A-18-013.03We recommend that FDA enter into a formal agreement with Federal agency partners, namely the DHS Industrial Control Systems Cyber Emergency Response Team, establishing roles and responsibilities as well as the support those agencies will provide to further FDA's mission related to medical device cybersecurity.- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/29/2018
- Legislative Related
- No
19-A-18-013.04We recommend that FDA ensure the establishment and maintenance of procedures for handling recalls of medical devices vulnerable to cybersecurity vulnerabilities, exploitations, and threats.- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/29/2018
- Legislative Related
- No
-
New York Claimed Federal Reimbursement for Some Assertive Community Treatment Services That Did Not Meet Medicaid Requirements
19-A-02-012.01We recommend that the State agency refund $4,414,469 to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $4,414,469
- Last Update Received
- -
- Closed Date
- 06/26/2023
- Legislative Related
- No
19-A-02-012.02We recommend that the State agency ensure that ACT program guidance on claiming Medicaid reimbursement for services is reinforced with providers.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/26/2018
- Legislative Related
- No
19-A-02-012.03We recommend that the State agency continue to improve monitoring of the ACT program.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/26/2018
- Legislative Related
- No
-
Professional Clinical Laboratory, Inc., Generally Did Not Comply With Medicare Requirements For Billing Phlebotomy Travel Allowances
19-A-06-011.01We recommend that ProLab refund to the Medicare program the portion of the estimated $319,277 overpayment for claims incorrectly billed that are within the reopening period.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $319,277
- Last Update Received
- -
- Closed Date
- 10/24/2018
- Legislative Related
- No
19-A-06-011.02We recommend that ProLab, for the remaining portion of the estimated $319,277 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 Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/24/2018
- Legislative Related
- No
19-A-06-011.03We recommend that ProLab 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 Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/24/2018
- Legislative Related
- No
-
Medicare Compliance Review of Mobile Infirmary Medical Center
19-A-04-009.01We recommend that the Hospital refund to the Medicare contractor $340,125 in estimated overpayments for the audit period for claims that it incorrectly billed.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $340,125
- Last Update Received
- -
- Closed Date
- 02/19/2019
- Legislative Related
- No
19-A-04-009.02We recommend that the Hospital exercise reasonable diligence to identify and return any additional similar overpayments received outside of our audit period, in accordance with the 60-day repayment rule.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/19/2019
- Legislative Related
- No
19-A-04-009.03We recommend that the Hospital strengthen controls to ensure full compliance with Medicare requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/19/2019
- Legislative Related
- No
-
Hospitals Reported Improved Preparedness for Emerging Infectious Diseases After the Ebola Outbreak
19-E-06-001.01ASPR, CDC, and CMS should continue to help hospitals sustain preparedness for emerging infectious diseases by coordinating guidance and providing practical advice for all hospitals.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/22/2020
- Legislative Related
- No
19-E-06-001.02ASPR, CDC, and CMS should continue to help hospitals sustain preparedness for emerging infectious diseases by coordinating guidance and providing practical advice for all hospitals.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/22/2020
- Legislative Related
- No
19-E-06-001.03ASPR, CDC, and CMS should continue to help hospitals sustain preparedness for emerging infectious diseases by coordinating guidance and providing practical advice for all hospitals.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/22/2020
- Legislative Related
- No
19-E-06-001.04CDC should clarify and promote the details and ongoing status of its tiered framework to ensure that hospitals are aware of their responsibilities in the event of a future emerging infectious disease.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/15/2019
- Legislative Related
- No
19-E-06-001.05CMS should add emerging infectious diseases to the definition of “all hazards” in the State Operations Manual to promote inclusion of emerging infectious diseases in hospital emergency planning.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/12/2019
- Legislative Related
- No
-
States Follow a Common Framework in Responding to Breaches of Medicaid Data
19-E-09-002.01CMS should reissue guidance to States about reporting Medicaid breaches to CMS.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/26/2019
- Legislative Related
- No
-
Wisconsin Did not Comply With Federal Waiver and State Requirements at all 20 Adult Day Care Centers Reviewed
19-A-05-005.01We recommend that the State agency ensure that the 208 instances of noncompliance with health and safety and administrative requirements identified in this report are corrected.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/04/2021
- Legislative Related
- No
19-A-05-005.02We recommend that the State agency consider revising staffing standards and caseload thresholds for State surveyors.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/18/2019
- Legislative Related
- No
19-A-05-005.03We recommend that the State agency update the certification checklist and promulgate rules as required by Wisconsin Statutes.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/04/2021
- Legislative Related
- No
19-A-05-005.04We recommend the State agency identify and address reasons for low attendance by center personnel at training programs.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/18/2019
- Legislative Related
- No
19-A-05-005.05We recommend the State agency increase State agency guidance on certification requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/18/2019
- Legislative Related
- No
-
Florence Crittenton Services of Orange County, Inc., Did Not Always Claim Expenditures in Accordance With Federal Requirements
19-A-09-004.01We recommend that Crittenton refund to the Federal Government $342,263 for unallowable expenditures claimed.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- $342,263
- Last Update Received
- -
- Closed Date
- 03/18/2021
- Legislative Related
- No
19-A-09-004.02We recommend that Crittenton review its claimed expenditures for FY 2016 (the third year of the grant awards) to determine whether they were claimed in accordance with Federal requirements and refund to the Federal Government any unallowable amount.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/18/2021
- Legislative Related
- No
19-A-09-004.03We recommend that Crittenton strengthen its oversight, through additional supervisory review, of expenditures charged to grant awards to ensure that they are claimed in accordance with Federal requirements.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/18/2021
- Legislative Related
- No
19-A-09-004.04We recommend that Crittenton implement adequate policies and procedures to ensure that it identifies and claims actual expenditures incurred for services and shelter care provided to UAC.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- $299,672
- Last Update Received
- -
- Closed Date
- 03/18/2021
- Legislative Related
- No
19-A-09-004.05We recommend that Crittenton work with ORR to determine what portion of the $3,251,090 claimed was unallowable and refund to the Federal Government the unallowable amount.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/18/2021
- Legislative Related
- No
-
Pennsylvania Generally Complied With Maternal, Infant, and Early Childhood Home Visiting Program Requirements
19-A-03-003.01Determine whether ECSD expended the $252,399 according to program requirements and refund to the Federal Government any amount not expended according to program requirements.- Status
- Closed Implemented
- Responsible Agency
- HRSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/08/2019
- Legislative Related
- No
19-A-03-003.02Develop additional written procedures to provide monitoring and oversight of subrecipient financial management to ensure that subrecipients' general ledgers accurately reflect the costs claimed on their expenditure reports.- Status
- Closed Implemented
- Responsible Agency
- HRSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/08/2019
- Legislative Related
- No
-
Ohio Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries' Deaths Audit
19-A-05-002.01We recommend that the State agency refund $37,974,949 to the Federal Government.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $37,974,949
- Last Update Received
- -
- Closed Date
- 11/04/2020
- Legislative Related
- No
19-A-05-002.02We recommend that the State agency identify and recover unallowable payments made to MCOs during our audit period on behalf of deceased beneficiaries, which we estimate to be at least $51,294,467- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/20/2019
- Legislative Related
- No
19-A-05-002.03We recommend that the State agency identify capitation payments made on behalf of deceased beneficiaries before and after our audit period, and repay the Federal share of amounts recovered.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/28/2023
- Legislative Related
- No
19-A-05-002.04We recommend that the State agency ensure that Ohio Benefits alerts county case workers of beneficiaries' DODs and that DODs are recorded in a timely manner to prevent unallowable payments.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/20/2019
- Legislative Related
- No
-
Many Inpatient Rehabilitation Facility Stays Did Not Meet Medicare Coverage and Documentation Requirements
18-A-01-162.01We recommend that CMS educate IRF clinical and billing personnel on Medicare coverage and documentation requirements and work with providers to identify, develop and share compliance best practices that may lead to improved internal controls.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/29/2019
- Legislative Related
- No
18-A-01-162.02We recommend that CMS increase oversight activities for IRFs, such as postpayment medical review, to determine compliance with coverage and documentation requirements, including a review of a subsample of the 135 IRFs in this review that had 1 or more sampled stays that did not comply with Medicare requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/04/2019
- Legislative Related
- No
18-A-01-162.03We recommend that CMS work with the Office of Medicare Hearings and Appeals to further evaluate the ALJ hearing process and make any necessary improvements to ensure that Medicare coverage and documentation requirements for IRF care are fairly represented.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/05/2019
- Legislative Related
- No
18-A-01-162.04We recommend that CMS reevaluate the IRF payment system, which could include conducting a demonstration project requiring prior authorization for Part A IRF stays modeled on Medicare Advantage practices; studying the relationship between IRF PPS payment rates and costs and seek legislative authority to make any changes necessary to more closely align them; and considering the high error rate found in this report and CERT reviews in future acute inpatient rehabilitation service payment reform, which may be a component of a unified post-acute-care PPS system.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/01/2023
- Legislative Related
- No