Recommendations Tracker

FDA should include cybersecurity documentation as a criterion in FDA's Refuse-to-Accept checklists.

We recommend that NIT exercise reasonable diligence to identify and return any additional similar overpayments related to cost reports that were not part of our audit in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation.

We recommend that the Fort Peck Tribes develop and implement controls to verify that FFRs and Carryover Reports accurately report the amount of unobligated funds in the current year and to ensure that the tribes repay to the Federal Government amounts that can no longer be obligated because those amounts exceeded the 2-year grant period.

We recommend that the Fort Peck Tribe develop and implement policies and procedures to track credit balances in beneficiaries' accounts held by energy suppliers to ensure that all unused LIHEAP funds are returned to the tribe so that excess funds can be used to provide assistance for additional benefits and for other purposes, such as crisis situations and residential weatherization, as described in the Manual.

We recommend that the Fort Peck Tribes maintain documentation, to include an up-to-date client listing and data on the number of households receiving LIHEAP assistance, to support the information reported in the Household Reports that they submit to ACF.

We recommend that the State agency improve its oversight and monitoring of providers.

We recommend that Liberty 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.

We recommend that Liberty improve its order-processing system to maintain adequate proof-of-delivery documentation.

We recommend that CMS work with the Medicare contractors to educate hospitals on properly billing Medicare for IMRT planning services.

We recommend that CMS direct the Medicare contractors to review claim lines that are within the 4-year claim-reopening period for emergency ambulance transports to destinations other than hospitals or SNFs that might have been covered by Medicare for nonemergency ambulance transports and recover any improper payments identified, which could represent $928,092 in improper payments.

We recommend that CMS direct the Medicare contractors to review claim lines after our audit period for emergency ambulance transports to destinations not covered by Medicare and recover any improper payments identified.

We recommend that CMS based on the results of the Medicare contractors' review of emergency ambulance transports to destinations other than hospitals or SNFs that might have been covered by Medicare for nonemergency ambulance transports, consider (1) directing the Medicare contractors to review claim lines after our audit period and recover any improper payments identified and (2) requiring the Medicare contractors to implement nation-wide prepayment edits specific to emergency ambulance transports that would either deny payment or mandate prepayment review for emergency ambulance transports to destinations other than hospitals or SNFs that might have been covered by Medicare for nonemergency ambulance transports.

We recommend that CMS work with Treasury and QHP issuers to resolve the potentially improper financial assistance payments, which we estimate to be $504,889,518, for policies for which there was no documentation provided to verify enrollees had paid their premiums.

We recommend that the State agency work with CMS to resolve the $1,154,016,418 of additional Medicaid placeholders reported on the CMS-64 for FY 2013 and any placeholders reported on the CMS-64 for prior and later FYs and determine whether adjustments should be made to the amounts reported.

We recommend that the State agency report on the CMS-64 only actual expenditures that are supported by documentation.

We recommend that the State agency strengthen its oversight of the health plans to ensure that SMHS claims comply with Federal and State requirements by implementing oversight procedures, such as conducting more frequent and focused reviews of the health plans, providing additional training and technical assistance to the plans, and imposing fines, sanctions, or penalties on the plans.

We recommend that the State agency strengthen its oversight of the health plans to ensure that SMHS claims comply with Federal and State requirements by implementing policies and procedures to follow up on the implementation of each health plan's plan of correction in a timely manner.

CMS should conduct additional analysis on compounded topical drugs.

CMS should follow up on pharmacies with questionable Part D billing and the prescribers associated with these pharmacies.

CMS should strengthen validation rules and revise data element definitions so that actual drug and device names must be reported.

CMS should ensure that valid national drug codes are reported for drugs.

We 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 rule, and identify any returned overpayments as having been made in accordance with this recommendation.

CMS should analyze deficiency data to inform the survey process.

CMS should develop other claims-based information and include it on Hospice Compare.

CMS should ensure that a physician is involved in the decisions to start and continue general inpatient care.

CMS should take appropriate actions to follow up with hospices that engage in practices or have characteristics that raise concerns.

CMS should implement a comprehensive prepayment review strategy to address lengthy general inpatient care stays so that beneficiaries do not have to endure unnecessarily long periods of time in which their pain and symptoms are not controlled.

CMS should assess the current payment system to determine what changes may be needed to tie payments to beneficiaries' care needs and quality of care to ensure that services rendered adequately serve beneficiaries' needs.

CMS should include on Hospice Compare deficiency data from surveys, including information about complaints filed and resulting deficiencies.

We recommend that the Passamaquoddy Tribe at Pleasant Point establishes clear lines of authority between the health director's administrative duties and the medical staff's duties to provide care by defining job responsibilities as well as policies and procedures that ensure medical complaints are resolved by staff with the appropriate clinical training who can assess and evaluate patient-care decisions and patient-care decisions are prioritized with appropriate input from medical staff during periods of limited funding.

We recommend that the Passamaquoddy Tribe at Pleasant Point conduct annual program evaluations in accordance with Federal requirements.

We recommend that the Passamaquoddy Tribe at Pleasant Point provide a safe, clean, and accessible environment with a preventative maintenance program for the facility and medical equipment for the provision of health care.

We recommend that WPS improve procedures to distinguish between allowable and unallowable costs in accordance with the applicable Medicare contract, CAS, and FAR provisions; specifically ensure that when an unallowable cost is incurred, its directly associated costs are properly identified and excluded, and ensure that revenue, payroll, and NBV of assets percentages used in developing 3FF rates are consistent with guidance defined in the CAS and the FAR provisions defining reasonableness.

We recommend that WPS improve procedures to distinguish between allowable and unallowable costs in accordance with the applicable Medicare contract, CAS, and FAR provisions; specifically ensure that when an unallowable cost is incurred, its directly associated costs are properly identified and excluded, and ensure that revenue, payroll, and NBV of assets percentages used in developing 3FF rates are consistent with guidance defined in the CAS and the FAR provisions defining reasonableness.

We recommend that DHS refund to the Federal Government $105,770 in unallowable expenditures.

We recommend that DHS provide enhanced oversight of subrecipients to ensure that costs are claimed in accordance with Federal requirements.