Recommendations Tracker
HHS-OIG provides independent and objective oversight that promotes economy, efficiency, and effectiveness in HHS programs and operations. To drive this positive change, we produce reports and identify recommendations for improvement. We have developed this public-facing page for tracking all of our open recommendations.
Use the Top Unimplemented View below to read OIG's Top Unimplemented Recommendations. In OIG’s view, these top recommendations for HHS programs, if implemented, would have the greatest impact in terms of cost savings, program effectiveness and efficiency, and public health and safety. Learn more
Summary of All Recommendations
Updated Monthly · Last updated on April 15, 2026
1,094
Unimplemented
recommendations
3,367
Implemented and Closed
recommendations since FY 2017
Views
OIG Recommendations Grouped by Report
Showing 941–960 of 1,385 reports, containing 4,461 recommendations
Sorted by latest release date
-
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
- 04/14/2026
- Next Update Expected
- 10/14/2026
- 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
- 04/14/2026
- Next Update Expected
- 10/14/2026
- 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
- 04/14/2026
- Next Update Expected
- 10/14/2026
- 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
- 04/14/2026
- Next Update Expected
- 10/14/2026
- 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
- 04/14/2026
- Next Update Expected
- 10/14/2026
- 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
- 04/14/2026
- Next Update Expected
- 10/14/2026
- 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
- 04/14/2026
- Next Update Expected
- 10/14/2026
- 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
-
Massachusetts Did Not Ensure Its Managed-Care Organizations Complied With Requirements Prohibiting Medicaid Payments for Services Related to Provider-Preventable Conditions
19-A-01-085.01We recommend that the State agency work with the MCOs to determine the portion of the $9,971,471 that was unallowable for claims containing PPCs and its impact on current and future year capitation payment rates.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/23/2020
- Legislative Related
- No
19-A-01-085.02We recommend that the State agency enforce the requirement in its managed-care contracts that makes MCO compliance with the PPC provisions a condition of their payment and includes the specific means to recoup funds from the MCOs when such contract provisions and Federal and State requirements are not met—a measure that, if incorporated, could result in cost savings for the Medicaid program.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/23/2020
- Legislative Related
- No
19-A-01-085.03We recommend that the State agency enforce the requirement in its managed-care contracts that allows intermediate sanctions to be imposed upon the MCO for failure to comply with applicable Federal or State statutory or regulatory requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/23/2020
- Legislative Related
- No
19-A-01-085.04We recommend that the State agency require the MCOs to implement internal controls to prohibit payments for inpatient hospital services related to treating PPCs and ensure edits implemented after our audit period are effective.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/23/2020
- Legislative Related
- No
19-A-01-085.05We recommend that the State agency require its MCOs to review all claims for inpatient hospital services that were paid after our audit period to determine whether any payments for services related to treating PPCs were unallowable and adjust future capitation payment rates for any unallowable payments identified.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/23/2020
- Legislative Related
- No
19-A-01-085.06We recommend that the State agency strengthen its monitoring of MCOs to ensure that they comply with Federal and State requirements and the State's managed-care contracts relating to the nonpayment of PPCs.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/23/2020
- Legislative Related
- No
19-A-01-085.07We recommend that the State agency ensure that claims identified by the MMIS edit are referred back to the MCOs for appropriate correction and inclusion of missing POA codes.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/23/2020
- Legislative Related
- No
-
California Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries' Deaths
19-A-04-083.01We recommend that the State Agency refund $53,425,143 to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $53,425,143
- Last Update Received
- -
- Closed Date
- 07/15/2021
- Legislative Related
- No
19-A-04-083.02We 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 Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/29/2019
- Legislative Related
- No
19-A-04-083.03We recommend that the State Agency identify and recover unallowable payments made to MCOs during our audit period on behalf of deceased beneficiaries, which we estimated to be at least $70,989,604.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/15/2021
- Legislative Related
- No
19-A-04-083.04We recommend that the State Agency perform quarterly reviews of eligibility system records to ensure that beneficiaries with dates of death are removed from Medi-Cal.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/16/2021
- Legislative Related
- No
19-A-04-083.05We recommend that the State Agency use additional sources of date of death consistently to help reduce unallowable payments.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/29/2019
- Legislative Related
- No
-
One Percent of Drugs With Medicaid Reimbursement Were Not FDA-Approved
19-E-03-013.01CMS should work with States to recoup any potentially inappropriate Federal reimbursement for drugs that CMS determines were not FDA-approved and did not meet the criteria for an exception.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/02/2024
- Legislative Related
- No
19-E-03-013.02CMS should continue to improve its reporting system to prevent inappropriate reimbursement for drugs that are not FDA approved.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/21/2020
- Legislative Related
- No
19-E-03-013.03CMS should work with States to ensure that they prevent inappropriate reimbursement for drugs that are not FDA-approved and do not meet the criteria for an exception.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/04/2021
- Legislative Related
- No
-
Some Diagnosis Codes That Essence Healthcare, Inc., Submitted to CMS Did Not Comply With Federal Requirements
19-A-07-082.01We recommend that Essence refund to the Federal Government the $158,904 in overpayments.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $158,904
- Last Update Received
- -
- Closed Date
- 12/07/2020
- Legislative Related
- No
19-A-07-082.02We recommend that Essence identify, for the diagnoses included in this report, instances of noncompliance in the enrollee-years that occurred during our audit period, but were not included in our judgmental sample, and before and after our audit period, and refund any resulting overpayments to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/22/2021
- Legislative Related
- No
19-A-07-082.03We recommend that Essence enhance its policies and procedures to detect and correct noncompliance with Federal requirements for all diagnosis codes used to calculate risk-adjusted payments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 03/31/2020
- Next Update Expected
- 10/30/2022
- Legislative Related
- No
-
Medicaid Could Save Hundreds of Millions by Excluding Authorized Generic Drug Transactions to Secondary Manufacturers from Brand Name Drugs' Average Manufacturer Price Calculations
19-A-06-081.01We recommend that CMS seek legislative change to exclude authorized generic drug transactions to secondary manufacturers from the AMP calculation of the brand name drug.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/13/2023
- Legislative Related
- Yes
-
The Children's Village, Inc., an Administration for Children and Families Grantee, Did Not Always Comply with Applicable Federal and State Policies and Requirements
19-A-02-079.01We recommend that Children's Village take corrective action to ensure that its facility is free from potentially harmful conditions.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/23/2025
- Legislative Related
- No
19-A-02-079.02We recommend that Children's Village determine whether resources are aligned as needed to ensure that all required documentation is maintained in UAC case files and that ORR policies and procedures are followed when releasing UAC to sponsors.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/23/2025
- Legislative Related
- No
19-A-02-079.03We recommend that Children's Village ensure that all medical exams and educational assessments are documented and performed as required by ORR.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/23/2025
- Legislative Related
- No
19-A-02-079.04We recommend that Children's Village ensure that all employee requirements pertaining to background investigations and experience are met and documented.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/18/2026
- Legislative Related
- No
19-A-02-079.05We recommend that Children's Village refund to the Federal Government $2,623,785 in unallowable grant expenditures.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Partial Concur
- Potential Savings
- $2,623,785
- Last Update Received
- -
- Closed Date
- 07/23/2025
- Legislative Related
- No
19-A-02-079.06We recommend that Children's Village review its claimed expenditures for FYs 2016 and 2017 (the second and third years 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
- 02/26/2026
- Legislative Related
- No
19-A-02-079.07We recommend that Children's Village ensure that costs are properly approved, allocated, and adequately supported.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/26/2026
- Legislative Related
- No
19-A-02-079.08We recommend that Children's Village implement financial management system procedures to ensure Federal funds are drawn down only when needed, all related obligations are paid timely, and grant funds are separately identified and segregated.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/23/2025
- Legislative Related
- No
-
The Centers for Disease Control and Prevention's South Africa Office Generally Implemented Our Prior Audit Recommendation
19-A-04-078.01We recommend that CDC-SA continue to strengthen its CoAg tracking process, by consistently completing a grant file checklist at the end of the CoAg's budget period, to ensure that reviews of the CoAgs are completed by the appropriate staff; completed in a timely manner; and maintained in the recipient CoAg file.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/25/2019
- Legislative Related
- No
19-A-04-078.02We recommend that CDC-SA continue to update and review its SOPs annually to include specific and clear procedures when changes in control activities occur for monitoring recipient CoAgs, such as, but not limited to, review of the expenditures and the time limit of the audit report review.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/25/2019
- Legislative Related
- No