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 901–920 of 1,352 reports, containing 4,352 recommendations
Sorted by latest release date
-
The Food and Drug Administration Generally Complied With Federal Requirements for the Preparation and Receipt of Select Agent Shipments
19-A-03-106.01We recommend that FDA update its registered entities' security plans to include procedures for notifying FSAP if a select agent shipment is not received within 48 hours after the expected time of delivery.- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/25/2021
- Legislative Related
- No
19-A-03-106.02We recommend that FDA update its registered entities' security plans to include procedures for notifying FSAP if a select agent package is received damaged to the extent that a release of the select agent may have occurred.- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/25/2021
- Legislative Related
- No
19-A-03-106.03We recommend that FDA update its registered entities' security plans to include procedures for notifying FSAP if a select agent shipment will not be completed within 30 calendar days after transfer authorization issuance.- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/25/2021
- Legislative Related
- No
19-A-03-106.04We recommend that FDA update its registered entities' security plans to include procedures for notifying FSAP if a select agent transfer authorization becomes void because the facts supporting the authorization changed.- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/25/2021
- Legislative Related
- No
19-A-03-106.05We recommend that FDA ensure that its registered entities verify and maintain documentation to assure that employees who are required to have select agent training understand the training received.- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/25/2021
- Legislative Related
- No
19-A-03-106.06We recommend that FDA Update its policies for shipping inactivated select agents to require that its registered entities record a description of the viability testing protocol used, the names of the personnel who inactivated the select agent, and the location of the inactivation.- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/25/2021
- Legislative Related
- No
-
The Florida Department of Children and Families Made Some Unallowable Refugee Cash Assistance Payments
19-A-04-105.01We recommend that DCF refund $114,504 to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- $114,504
- Last Update Received
- -
- Closed Date
- 09/21/2020
- Legislative Related
- No
19-A-04-105.02We recommend that DCF provide staff training on Federal regulations and State policies and procedures related to the eligibility review process and maintaining sufficient documentation to verify entry and asylum dates.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/21/2020
- Legislative Related
- No
19-A-04-105.03We recommend that DCF revise current policy to ensure the recovery of overpayments.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/21/2020
- Legislative Related
- No
-
Illinois Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs
19-A-05-103.01We recommend that the State agency work with CMS to determine the unallowable portion of $258,640 (Federal share) for other claims for covered outpatient physician-administered drugs that were submitted without NDCs or had invalid NDCs and that may have been ineligible for Federal reimbursement and refund that amount.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $258,640
- Last Update Received
- -
- Closed Date
- 08/12/2020
- Legislative Related
- No
19-A-05-103.02We recommend that the State agency work with CMS to determine and refund the unallowable portion of Federal reimbursement for physician-administered drugs that were not invoiced for rebates after September 30, 2017.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/12/2020
- Legislative Related
- No
19-A-05-103.03We recommend that the State agency 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
- 08/12/2020
- Legislative Related
- No
19-A-05-103.04We recommend that the State agency refund to the Federal Government $4,032,568 (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
- $4,032,568
- Last Update Received
- -
- Closed Date
- 08/12/2020
- Legislative Related
- No
19-A-05-103.05We recommend that the State agency refund to the Federal Government $32,620 (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
- $32,620
- Last Update Received
- -
- Closed Date
- 08/12/2020
- Legislative Related
- No
-
Medicare Could Have Saved Millions of Dollars in Payments for Three-Dimensional Conformal Radiation Therapy Planning Services
19-A-09-102.01We recommend that CMS implement billing requirements (including, for example, a bundled payment similar to that for IMRT planning services) and system edits to prevent additional payments for 3D-CRT planning services that are billed before (e.g., up to 14 days before) 3D-CRT planning CPT code 77295 is billed, which could have saved Medicare as much as $125,377,027 during CYs 2008 through 2017 and as much as $13,601,090 in CY 2018.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $138,978,117
- Last Update Received
- -
- Closed Date
- 05/18/2020
- Legislative Related
- No
-
Alaska Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities
19-A-09-101.01We recommend that the State agency work with community-based providers on how to identify and report all critical incidents.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/25/2020
- Legislative Related
- No
19-A-09-101.02We recommend that the State agency perform analytical procedures, such as data matches, on Medicaid claims data to identify potential critical incidents that have not been reported and investigated as needed.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/20/2020
- Legislative Related
- No
-
The National Institutes of Health Could Improve Its Monitoring To Ensure That an Awardee of the All of Us Research Program Had Adequate Cybersecurity Controls To Protect Participants' Sensitive Data
19-A-18-100.01We recommend that NIH revise its All of Us Cooperative Agreements and cooperative agreements with security and privacy requirements to include a detailed description of how NIH will monitor cybersecurity and ensure that future awardees adequately implement security controls to protect sensitive data.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/11/2019
- Legislative Related
- No
-
Most Hospitals Obtain Compounded Drugs From Outsourcing Facilities, Which Must Meet FDA Quality Standards
19-E-01-018.01FDA should further communicate to hospitals the importance of obtaining NPS compounded drugs from outsourcing facilities.- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/05/2021
- Legislative Related
- No
19-E-01-018.02FDA should take appropriate followup action with the unregistered compounding facilities on the list that we provided.- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/05/2021
- Legislative Related
- No
-
Incidents of Potential Abuse and Neglect at Skilled Nursing Facilities Were Not Always Reported and Investigated
19-A-01-097.01We recommend that CMS work with the Survey Agencies to improve training for staff of SNFs on how to identify and report incidents of potential abuse or neglect of Medicare beneficiaries.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/11/2023
- Legislative Related
- No
19-A-01-097.02We recommend that CMS clarify guidance to clearly define and provide examples of incidents of potential abuse or neglect.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/11/2023
- Legislative Related
- No
19-A-01-097.03We recommend that CMS require the Survey Agencies to record and track all incidents of potential abuse or neglect in SNFs and referrals made to local law enforcement and other agencies.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/11/2023
- Legislative Related
- No
19-A-01-097.04We recommend that CMS monitor the Survey Agencies' reporting of findings of substantiated abuse to local law enforcement.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/11/2023
- Legislative Related
- No
-
CMS Could Use Medicare Data To Identify Instances of Potential Abuse or Neglect
19-A-01-099.01We recommend that CMS compile a complete list of diagnosis codes that indicate potential physical or sexual abuse and neglect.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/19/2023
- Legislative Related
- No
19-A-01-099.02We recommend that CMS use the complete list of diagnosis codes to conduct periodic data extracts of all Medicare claims containing at least one of the codes indicating either potential abuse or neglect of adult and child Medicare beneficiaries.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/19/2023
- Legislative Related
- No
19-A-01-099.03We recommend that CMS inform States that the extracted Medicare claims data are available to help the States ensure compliance with their mandatory reporting laws.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/19/2023
- Legislative Related
- No
19-A-01-099.04We recommend that CMS assess the sufficiency of existing Federal requirements, such as CoPs and section 1150B of the Act, to report suspected abuse and neglect of Medicare beneficiaries, regardless of where services are provided, and strengthen those requirements or seek additional authorities as appropriate.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/16/2023
- Legislative Related
- No
-
Medicare Payments to Providers for Polysomnography Services Did Not Always Meet Medicare Billing Requirements
19-A-04-098.01We recommend that CMS instruct the MACs to recover the portion of the $56,668 in identified net overpayments that are within the 4-year reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $56,668
- Last Update Received
- -
- Closed Date
- 01/14/2021
- Legislative Related
- No
19-A-04-098.02We recommend that CMS instruct the MACs to notify the 117 providers associated with 147 claims (83 beneficiaries with 150 corresponding lines of service) with potential overpayments of $56,668 so that those providers can exercise reasonable diligence to investigate and return any identified overpayments, in accordance with the 60-day rule, and identify and track 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
- 01/14/2021
- Legislative Related
- No
19-A-04-098.03We recommend that CMS work with the MACs to conduct data analysis allowing for targeted reviews of claims for polysomnography services.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/19/2019
- Legislative Related
- No
19-A-04-098.04We recommend that CMS work with the MACs to educate providers on properly billing for polysomnography services, which could have reduced or eliminated an estimated $269,768,285 in overpayments over the 2-year audit period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $269,768,285
- Last Update Received
- -
- Closed Date
- 04/21/2020
- Legislative Related
- No
-
Nevada Medicaid Fraud Control Unit: 2018 Onsite Inspection
19-E-06-017.01Fill vacant positions now that the Unit is in a temporary workspace and continue to ensure that the Unit has a safe and adequate work environment.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/09/2020
- Legislative Related
- No
19-E-06-017.02Continue to take steps to increase the number of investigations of patient abuse and neglect.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/09/2020
- Legislative Related
- No
19-E-06-017.03Establish an annual training plan covering all professional disciplines within the Unit.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/09/2020
- Legislative Related
- No
-
Princeton Place Did Not Always Comply With Care Plans for Residents Who Were Diagnosed With Urinary Tract Infections
19-A-06-095.01We recommend that Princeton Place develop and implement policies and procedures requiring that its nursing staff follow and document compliance with the residents' care plans.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/17/2019
- Legislative Related
- No
19-A-06-095.02We recommend that Princeton Place develop and implement policies and procedures requiring that supervisors conduct reviews to ensure that the nursing staff follow and document compliance with residents' care plans.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/17/2019
- Legislative Related
- No
-
New York May Not Have Complied With Federal and State Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions
19-A-02-093.01We recommend that the State agency provide CMS with sufficient documentation to determine whether any portion of the $50,256,025 Federal Medicaid reimbursement was unallowable and refund to the Federal Government the unallowable amount.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $50,256,025
- Last Update Received
- -
- Closed Date
- 03/30/2020
- Legislative Related
- No
19-A-02-093.02We recommend that the State agency ensure that it has policies and procedures that are fully implemented and effective in prohibiting unallowable payments for services related to PPCs.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/30/2020
- Legislative Related
- No
19-A-02-093.03We recommend that the State agency work with its contractors to ensure that it maintains evidence to support that payments for claims containing PPCs are being prevented or reduced.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/30/2020
- Legislative Related
- No
19-A-02-093.04We recommend that the State agency review the inpatient hospital claims it processed and paid before and after our audit period and identify for refund to the Federal Government the Federal share of any improper payments related to services for treating PPCs.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/30/2020
- Legislative Related
- No
-
Great Lakes Home Health Services, Inc., Billed for Home Health Services That Did Not Comply With Medicare Coverage and Payment Requirements
19-A-05-092.01We recommend that Great Lakes for the remaining portion of the estimated $10,486,922 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
- $10,486,922
- Last Update Received
- -
- Closed Date
- 01/09/2023
- Legislative Related
- No
19-A-05-092.02We recommend that Great Lakes, for the remaining portion of the estimated $10,486,922 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
- $19,657
- Last Update Received
- -
- Closed Date
- 03/02/2020
- Legislative Related
- No
19-A-05-092.03We recommend that Great Lakes strengthen its procedures to ensure that: homebound statuses of Medicare beneficiaries are verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented and beneficiaries are receiving only reasonable and necessary skilled services.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/28/2019
- Legislative Related
- No
19-A-05-092.04We recommend that Great Lakes 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
- $17,369
- Last Update Received
- -
- Closed Date
- 03/02/2020
- Legislative Related
- No
-
St. Joseph's Hospital and Medical Center Submitted Some Inaccurate Wage Data
19-A-01-091.01We recommend that the Hospital ensure that all personnel involved in Medicare wage data reporting are fully trained in compliance with the requirements of the Provider Reimbursement Manual.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/05/2020
- Legislative Related
- No
19-A-01-091.02We recommend that the Hospital review all software scripts and manual procedures annually to ensure that the scripts and procedures result in wage data that meet the requirements of the Provider Reimbursement Manual.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/05/2020
- Legislative Related
- No
19-A-01-091.03We recommend that the Hospital implement more effective quality controls over the entry of contract labor data into the accounts payable system.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/05/2020
- Legislative Related
- No
-
Metropolitan Jewish Home Care, Inc., Billed for Home Health Services That Did Not Comply with Medicare Requirements
19-A-02-090.01We recommend that Metropolitan, for the estimated $2,979,377 overpayment for all claims 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
- $9,927
- Last Update Received
- -
- Closed Date
- 02/08/2022
- Legislative Related
- No
19-A-02-090.02We recommend that Metropolitan exercise reasonable diligence to identify and return any additional similar overpayments outside of our audit period, in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/08/2022
- Legislative Related
- No
19-A-02-090.03We recommend that Metropolitan strengthen its procedures to ensure that the homebound statuses of Medicare beneficiaries are verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented; beneficiaries are receiving only reasonable and necessary skilled services; and physicians' certifications comply with Medicare documentation requirements and its records support the services Metropolitan provided.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/04/2019
- Legislative Related
- No
-
Four States Did Not Comply With Federal Waiver and State Requirements in Overseeing Adult Day Care Centers and Foster Care Homes
19-A-05-089.01We recommend that CMS work with the States reviewed to ensure that the instances of noncompliance with health and safety and administrative requirements identified in this report are corrected.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/12/2024
- Legislative Related
- No
19-A-05-089.02We recommend that CMS assist all States to ensure the health and safety of vulnerable adults by offering technical assistance to look at staffing models in centers, homes, and other HCBS settings.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/14/2023
- Legislative Related
- No
19-A-05-089.03We recommend that CMS work with all States to review current training the States provide to centers and homes.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/02/2021
- Legislative Related
- No
19-A-05-089.04We recommend that CMS assist all States to ensure the health and safety of vulnerable adults by offering technical assistance to look at possible templates for administrative records in centers, homes, and other HCBS settings.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/14/2023
- Legislative Related
- No
-
EHS Home Health Care Service, Inc., Billed for Home Health Services That Did Not Comply With Medicare Coverage and Payment Requirements
19-A-05-088.01We recommend that EHS refund to the Medicare program the portion of the estimated $7,563,552 overpayment for claims incorrectly billed that are within the reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $7,563,552
- Last Update Received
- -
- Closed Date
- 05/07/2020
- Legislative Related
- No
19-A-05-088.02We recommend that EHS for the remaining portion of the estimated $7,563,552 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
- 08/21/2023
- Legislative Related
- No
19-A-05-088.03We recommend that EHS 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
- 08/21/2023
- Legislative Related
- No
19-A-05-088.04We recommend that EHS strengthen its procedures to ensure that the homebound statuses of Medicare beneficiaries are verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented and beneficiaries are receiving only reasonable and necessary skilled services.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/21/2023
- Legislative Related
- No
-
New Jersey Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs
19-A-02-086.01We recommend that the State agency refund to the Federal Government $7,578,002 (Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $7,578,002
- Last Update Received
- 09/12/2025
- Next Update Expected
- 03/12/2026
- Legislative Related
- No
19-A-02-086.02We recommend that the State agency refund to the Federal Government $561,937 (Federal share) for claims for top-20 multiple-source physician-administered drugs that were ineligible for Federal reimbursement.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $561,937
- Last Update Received
- 09/12/2025
- Next Update Expected
- 03/12/2026
- Legislative Related
- No
19-A-02-086.03We recommend that the State agency work with CMS to determine the unallowable portion of $7,889 (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.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $7,889
- Last Update Received
- 09/12/2025
- Next Update Expected
- 03/12/2026
- Legislative Related
- No
19-A-02-086.04We recommend that the State agency work with CMS to determine whether the remaining $1,109,110 (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
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/12/2025
- Next Update Expected
- 03/12/2026
- Legislative Related
- No
19-A-02-086.05We recommend that the State agency 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, 2016.- 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
19-A-02-086.06We recommend that the State agency develop and implement formal written policies and procedures for its drug rebate program.- 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
19-A-02-086.07We recommend that the State agency strengthen its internal controls to ensure that all physician-administered drugs eligible for rebates are invoiced.- 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
-
Excella HomeCare Billed for Home Health Services That Did Not Comply With Medicare Coverage and Payment Requirements
19-A-01-084.01We recommend that Excella for the estimated $6,636,091 overpayment for all claims outside of the Medicare reopening period, exercise reasonable diligence to identify and return overpayments in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/06/2020
- Legislative Related
- No
19-A-01-084.02We recommend that Excella 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
- 05/06/2020
- Legislative Related
- No
19-A-01-084.03We recommend that Excella strengthen its procedures to ensure that the homebound statuses of Medicare beneficiaries are verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented and beneficiaries are receiving only reasonable and necessary skilled services.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/06/2020
- Legislative Related
- No