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
-
New York Claimed Federal Reimbursement for Consumer-Directed Personal Assistance Services That Did Not Meet Medicaid Requirements
18-A-02-116.01We recommend that the State agency refund $74,871,340 to the Federal Government.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $74,871,340
- Last Update Received
- 09/12/2025
- Next Update Expected
- 03/12/2026
- Legislative Related
- No
18-A-02-116.02We recommend that the State agency reinforce guidance to the social services districts and providers related to CDPAP documentation and billing requirements.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/12/2019
- Legislative Related
- No
18-A-02-116.03We recommend that the State agency improve its monitoring of the CDPAP to ensure that social services districts and providers comply with CDPAP requirements.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/12/2019
- Legislative Related
- No
-
University of Wisconsin Hospitals and Clinics Authority Incorrectly Billed Medicare Inpatient Claims With Severe Malnutrition
18-A-03-115.01We recommend that the Hospital refund to the Medicare program $2,412,137 for the incorrectly coded claims.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $2,412,137
- Last Update Received
- -
- Closed Date
- 03/01/2019
- Legislative Related
- No
18-A-03-115.02We recommend that the Hospital 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
- 03/29/2019
- Legislative Related
- No
18-A-03-115.03We recommend that the Hospital strengthen controls to ensure full compliance with Medicare billing requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/22/2018
- Legislative Related
- No
-
Minnesota Did Not Comply With Federal Waiver and State Requirements for All 20 Adult Day Care Centers Reviewed
18-A-05-112.01We recommend that the State agency ensure that the 200 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
- 05/07/2021
- Legislative Related
- No
18-A-05-112.02We recommend that the State agency ensure the health and safety of vulnerable adults by considering staffing standards and caseload thresholds for State licensors.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/07/2021
- Legislative Related
- No
18-A-05-112.03We recommend that the State agency consider developing templates for administrative records the State requires.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/07/2021
- Legislative Related
- No
-
Nebraska Did Not Always Verify Correction of Deficiencies Identified During Surveys of Nursing Homes Participating in Medicare and Medicaid
18-A-07-114.01We recommend that the State agency revise its policies to (1) require nursing homes to include evidence of correction with all submitted correction plans for deficiencies with ratings of D or higher and (2) ensure that this evidence is retained by the State agency.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/04/2019
- Legislative Related
- No
18-A-07-114.02We recommend that the State agency maintain accessibility of, and the ability to read, survey data documentation in accordance with changes in technology.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/24/2019
- Legislative Related
- No
-
Nevada Did Not Comply With Federal and State Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions
18-A-09-111.01We recommend that the State agency strengthen its policies and procedures to ensure that it reviews inpatient hospital claims for all Medicare hospital-acquired conditions identified by CMS.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/09/2019
- Legislative Related
- No
18-A-09-111.02We recommend that the State agency review retrospective review reports for our audit period and after our audit period to determine whether payments should be reduced for any claims that contain PPCs and refund to the Federal Government its share of any unallowable amounts.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/08/2021
- Legislative Related
- No
18-A-09-111.03We recommend that the State agency strengthen its policies and procedures to ensure that it performs retrospective reviews of billing data from all inpatient hospitals to identify PPCs.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/07/2020
- Legislative Related
- No
-
HRSA Helped Health Centers With Elevated Risks and Can Continue To Take Additional Steps
18-E-05-017.01HRSA should ensure that it uses its risk management interventions as intended.- Status
- Closed Implemented
- Responsible Agency
- HRSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/20/2018
- Legislative Related
- No
18-E-05-017.02HRSA should explore additional steps it could take to help health centers reduce their elevated financial risks.- Status
- Closed Implemented
- Responsible Agency
- HRSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/20/2018
- Legislative Related
- No
-
Ohio Did Not Always Comply With Requirements Related to the Case Management of Children in Foster Care
18-A-05-110.01We recommend that the State agency ensure that the appropriate internal controls are in place for maintaining the required documentation in the case files to substantiate that children in foster care are receiving the necessary services.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/13/2018
- Legislative Related
- No
18-A-05-110.02We recommend that the State agency ensure that the county agencies maintain the required documentation in the caseworkers' personnel files.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/13/2018
- Legislative Related
- No
18-A-05-110.03We recommend that the State agency improve controls to ensure that critical incidents involving children in foster care residing in group homes are reported timely to the county agencies.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/13/2018
- Legislative Related
- No
18-A-05-110.04We recommend that the State agency implement controls to ensure that the appropriate criminal record checks are completed for the caseworkers upon hire and that the minimum training requirements are met and documented.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/30/2019
- Legislative Related
- No
-
CMS Did Not Always Provide Accurate Medicaid Unit Rebate Offset Amounts to State Medicaid Agencies
18-A-07-109.01We recommend that CMS conduct periodic matches that would compare the UROA information sent to the State agencies to the MDR system to ensure that CMS is sending accurate rebate information.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/05/2018
- Legislative Related
- No
-
The South African National Department of Health Did Not Always Manage and Expend the President's Emergency Plan for AIDS Relief Funds in Accordance With Award Requirements
18-A-04-108.01We recommend that the Ministry refund to CDC $12,734 for transactions that were not adequately supported.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- $12,374
- Last Update Received
- -
- Closed Date
- 05/23/2019
- Legislative Related
- No
18-A-04-108.02We recommend that the Ministry maintain adequate supporting documentation for expenditures.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/28/2022
- Legislative Related
- No
18-A-04-108.03We recommend that the Ministry work with CDC to obtain $343,930 of VAT reimbursement from the South African Government.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- $343,930
- Last Update Received
- -
- Closed Date
- 05/14/2021
- Legislative Related
- No
18-A-04-108.04We recommend that the Ministry develop and implement policies and procedures to ensure that it submits accurate FFRs on time.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/23/2019
- Legislative Related
- No
18-A-04-108.05We recommend that the Ministry develop and implement policies and procedures to ensure that it obtains VAT reimbursement.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/23/2019
- Legislative Related
- No
18-A-04-108.06We recommend that the Ministry implement policies and procedures to ensure that it prepares accurate FFRs.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/04/2020
- Legislative Related
- No
18-A-04-108.07We recommend that the Ministry implement polices and procedures that it maintains adequate supporting documentation for expenditures.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/28/2022
- Legislative Related
- No
18-A-04-108.08We recommend that the Ministry implement policies and procedures to ensure that it determines which cooperative agreement costs are assigned.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/28/2022
- Legislative Related
- No
18-A-04-108.09We recommend that the Ministry implement internal controls to ensure expenditures are assigned to the correct budget code.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/23/2019
- Legislative Related
- No
18-A-04-108.10We recommend that the Ministry implement training on the VAP process.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/14/2021
- Legislative Related
- No
18-A-04-108.11We recommend that the Ministry implement the unimplemented recommendations from our prior audit.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- $77,790
- Last Update Received
- -
- Closed Date
- 02/28/2022
- Legislative Related
- No
-
Missouri Did Not Comply With Federal and State Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions
18-A-07-106.01We recommend that the State agency work with CMS to determine what portion of the $1,709,925 (Federal share) was unallowable for Federal Medicaid reimbursement and refund that unallowable portion to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $148,995
- Last Update Received
- -
- Closed Date
- 01/16/2019
- Legislative Related
- No
18-A-07-106.02We recommend that the State agency develop and implement policies and procedures to ensure that all claims with PPCs that have certain POA codes are identified and adjusted in accordance with Federal and State requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/16/2019
- Legislative Related
- No
18-A-07-106.03We recommend that the State agency enhance its system edits to ensure that all claims that lack a valid POA code in the POA indicator data field are denied.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/16/2019
- Legislative Related
- No
18-A-07-106.04We recommend that the State agency ensure that its system edits use all of the diagnosis codes that appear on the list of Medicare hospital-acquired conditions when identifying PPCs.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/16/2019
- Legislative Related
- No
18-A-07-106.05We recommend that the State agency revise its system edits to ensure that the diagnosis codes used for payment reductions include only those codes that are included in the list of Medicare hospital-acquired conditions and that CMS has designated as CCs or MCCs.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/16/2019
- Legislative Related
- No
-
Iowa Complied With Most Federal Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions
18-A-07-107.01We recommend that the State agency issue a revised Informational Letter to require that all inpatient hospital types, including critical access hospitals, children's inpatient facilities, Indian Health Service facilities, and Veterans Administration and Department of Defense hospitals, report PPCs and appropriately reduce payments for PPCs for all future claims in accordance with Federal requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/25/2020
- Legislative Related
- No
18-A-07-107.02We recommend that the State agency obtain the POA codes for inpatient hospital types that were excluded due to the State agency's misinterpretation of the Federal requirements and identify and adjust any paid claims that were subject to payment reduction as a result of treating a PPC.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/25/2020
- Legislative Related
- No
18-A-07-107.03We recommend that the State agency revise its claims processing system edits to ensure that the payment reduction applies only to PPCs by including only those diagnosis codes that are included in the list of Medicare hospital-acquired conditions and that are considered a CC or MCCs.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/25/2020
- Legislative Related
- No
18-A-07-107.04We recommend that the State agency identify any paid claims that had an improper payment reduction from diagnosis codes that were not considered a CC or MCC and make the proper adjustments.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/25/2020
- Legislative Related
- No
-
Wisconsin Physicians Service Insurance Corporation Understated Medicare's Share of the Medicare Segment Excess Pension Assets
18-A-07-103.01We recommend that WPS increase Medicare's share of Medicare segment excess pension assets as of 12/31/2013 by $17,732,694 and recognize $13,807,170 as Medicare's share of the pension results as a result of the benefit curtailment.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $17,732,694
- Last Update Received
- -
- Closed Date
- 08/20/2018
- Legislative Related
- No
-
Wisconsin Physicians Service Insurance Corporation Understated Medicare Administrative Contract Allowable Pension Costs
18-A-07-104.01We recommend that WPS work with CMS to ensure that WPS's final settlement of contract costs reflects an increase in Medicare pension costs of $1,465,057 for CYs 2008-2013.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/20/2018
- Legislative Related
- No
-
The University of Alabama at Birmingham Overstated Chilled Water Costs in Its Facilities and Administrative Cost Proposal
18-A-04-102.01We recommended that UAB work with HHS's CAS to refund the unallowable portion (including any interest) to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- OS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/20/2019
- Legislative Related
- No
18-A-04-102.02We recommend that UAB work with HHS's CAS to ensure that appropriate officials review future F&A cost proposals for compliance with Federal requirements prior to submitting the proposals to CAS.- Status
- Closed Implemented
- Responsible Agency
- OS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/20/2019
- Legislative Related
- No
18-A-04-102.03We recommended that UAB work with HHS's CAS to determine the portion of the $5,901,378 that was unallowable under Federal requirements.- Status
- Closed Implemented
- Responsible Agency
- OS
- Response
- Concur
- Potential Savings
- $1,700,000
- Last Update Received
- -
- Closed Date
- 05/20/2019
- Legislative Related
- No
-
The National Institutes of Health, Division of Financial Advisory Services Did Not Always Establish Final Indirect Cost Rates in Accordance With Federal Requirements
18-A-04-101.01We recommended that DFAS update its policies and procedures to conform to applicable requirements and best practices for determining the adequacy of final indirect cost rate proposals.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/28/2018
- Legislative Related
- No
18-A-04-101.02We recommended that DFAS update its policies and procedures to require consideration of all FAR requirements for assessing the allowability of proposed costs including the support of proposed costs with adequate documentation and the appropriateness of data elements within direct cost bases for the fair distribution of indirect costs to applicable cost objectives.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/27/2018
- Legislative Related
- No
18-A-04-101.03We recommended that DFAS update its policies and procedures to define reasonable periods for promptly establishing final indirect cost rates.- Status
- Closed Unimplemented
- Responsible Agency
- NIH
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/27/2018
- Legislative Related
- No
18-A-04-101.04We recommended that DFAS ensure that indirect cost rate ceilings are properly applied for current or future rate proposals in which rate ceilings had been established under provisional rate agreements.- Status
- Closed Unimplemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/27/2018
- Legislative Related
- No
18-A-04-101.05We recommended that DFAS work with ASFR and OAMP, as applicable, to clarify the extent of DFAS's roles and responsibilities as a cognizant Federal agency for establishing final indirect cost rates.- Status
- Closed Unimplemented
- Responsible Agency
- NIH
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/27/2018
- Legislative Related
- No
18-A-04-101.06We recommended that DFAS work with ASFR and OAMP, as applicable, to formally adopt a set of professional auditing standards, such as generally accepted government auditing standards.- Status
- Closed Unimplemented
- Responsible Agency
- NIH
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/27/2018
- Legislative Related
- No
18-A-04-101.07We recommended that DFAS seek approval from appropriate authorities if it intends to deviate from any pertinent requirements of the FAR.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/27/2018
- Legislative Related
- No
-
Cahaba Government Benefits Administrators, LLC, Generally Claimed Allowable Medicare Pension Costs
18-A-07-098.01We recommend that Cahaba GBA revise its FACPs for FYs 2010 through 2013 to reduce its claimed Medicare pension costs by $92,392.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $92,392
- Last Update Received
- -
- Closed Date
- 03/03/2022
- Legislative Related
- No
-
Cahaba Government Benefits Administrators, LLC, Understated Medicare Administrative Contract Allowable Pension Costs
18-A-07-099.01We recommend that Cahaba GBA work with CMS to ensure that its final settlement of contract costs reflects an increase in Medicare pension costs of $2.6 million for CYs 2008 through 2013.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/24/2019
- Legislative Related
- No
-
Cahaba Safeguard Administrators, LLC, Understated Medicare Administrative Contract Allowable Pension Costs
18-A-07-100.01We recommend that Cahaba CSA work with CMS to ensure that its final settlement of contract costs reflects an increase in Medicare pension costs of $104,958 for CYs 2008 through 2013.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/24/2019
- Legislative Related
- No
-
Florida Did Not Always Verify Correction of Deficiencies Identified During Surveys of Nursing Homes Participating in Medicare and Medicaid
18-A-04-097.01We recommend that the State agency improve its practices for verifying nursing homes' correction of identified deficiencies by obtaining nursing homes' evidence of correction for less serious deficiencies.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/19/2019
- Legislative Related
- No
18-A-04-097.02We recommend that the State agency update information system controls to ensure that survey system data is protected against unauthorized or unintended modification or loss.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/19/2019
- Legislative Related
- No
-
Cahaba Government Benefits Administrators, LLC, Overstated Its Medicare Segment Pension Assets
18-A-07-095.01We recommend that Cahaba GBA decrease the Medicare segment pension assets by $622,074 and recognize $25,526,227 as the Medicare segment pension assets as of January 1, 2014.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/21/2018
- Legislative Related
- No
18-A-07-095.02We recommend that Cahaba GBA establish policies and procedures to ensure compliance with Federal requirements and the pension segmentation language of the Medicare contracts.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/21/2018
- Legislative Related
- No