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 May 15, 2026
1,085
Unimplemented
recommendations
3,387
Implemented and Closed
recommendations since FY 2017
Views
OIG Recommendations Grouped by Report
Showing 141–160 of 1,390 reports, containing 4,472 recommendations
Sorted by latest release date
-
Medicare and Medicaid Payments to Providers Are at Risk of Diversion Through Electronic Funds Transfer Fraud Schemes
25-E-07-017.01CMS should engage Medicare Administrative Contractors regarding opportunities and barriers to improving security measures for electronic funds transfers that were reported in response to OIG's survey.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/13/2025
- Legislative Related
- No
25-E-07-017.02CMS should share information with State Medicaid agencies to help address challenges implementing security measures to protect against electronic funds transfer fraud.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/28/2025
- Legislative Related
- No
25-E-07-017.03CMS should support periodic information sharing among Medicare and Medicaid payors and expert groups to mitigate evolving threats of electronic funds transfer fraud schemes.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 07/14/2025
- Next Update Expected
- 07/28/2026
- Legislative Related
- No
-
Medicare Contractors Did Not Use Complete and Timely Utilization Data When Making Part B Coverage Determinations for Stelara
25-E-BL-015.01CMS should assist MACs in obtaining more complete and timely utilization data with which to make coverage determinations.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/17/2025
- Legislative Related
- No
25-E-BL-015.02CMS should provide guidance on how MACs should account for enrollees who receive injections in both home and professional settings when performing their comparisons.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/05/2025
- Next Update Expected
- 09/25/2026
- Legislative Related
- No
-
Mental Health Center of Florida Generally Met Medicare Billing Requirements for Some Psychotherapy Services
25-A-04-045.01We recommend that the Mental Health Center of Florida monitor and evaluate the effectiveness of the QA program updates to ensure that documenting of time spent on psychotherapy services meets Medicare requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/26/2025
- Legislative Related
- No
-
Medicare Paid Claims That Were Not in Accordance With the Over-the- Counter COVID-19 Test Kits Demonstration Quantity Limitation
25-A-06-046.01We recommend that, for items or services for which the Medicare program establishes a quantity limit, CMS use the results of this audit to research and determine the best method(s) (e.g., nationwide system edits, information-sharing between providers, and other mechanisms) to detect and prevent improper payments to providers.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/24/2025
- Legislative Related
- No
-
Massachusetts Generally Claimed Safety Net Care Pool Costs That Complied With Federal Requirements
25-A-04-047.01We recommend that the Massachusetts Executive Office of Health and Human Services recover from IMDs and CBDCs $21,606,437 in SNCP payments that exceeded the cost of caring for Medicaid and uninsured patients.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/01/2026
- Legislative Related
- No
25-A-04-047.02We recommend that the Massachusetts Executive Office of Health and Human Services correct its $6,239,386 overstatement of CPEs on the CMS-64, which represents the difference between its CPE estimates and the actual uncompensated care provided to uninsured patients for State-owned hospitals.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/01/2026
- Legislative Related
- No
25-A-04-047.03We recommend that hte Massachusetts Executive Office of Health and Human Services refund to the Federal government the $13,922,912 Federal share of the total $27,845,823 in SNCP expenditures that did not comply with Federal requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $13,922,912
- Last Update Received
- 04/30/2026
- Next Update Expected
- 11/01/2026
- Legislative Related
- No
25-A-04-047.04We recommend that the Massachusetts Executive Office of Health and Human Services develop and implement policies and procedures that instruct personnel to perform interim and final reconciliations required by the STCs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/30/2026
- Next Update Expected
- 11/01/2026
- Legislative Related
- No
25-A-04-047.05We recommend that the Massachusetts Executive Office of Health and Human Services perform reconciliations for the SFYs following our audit period, where the required Medicare cost reports or UFRs are available. In addition, it should refund the Federal share of any oversated CPEs, as well as recover any overpayments to IMDs and CBDCs and refund the Federal share.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/30/2026
- Next Update Expected
- 11/01/2026
- Legislative Related
- No
-
Colorado Made Capitation Payments to Managed Care Organizations After Enrollees’ Deaths
25-A-07-044.01We recommend that the Colorado Department of Health Care Policy and Financing refund $6,012,198 to the Federal Government, consisting of $3,509,358 (Federal share) of capitation payments made on behalf of deceased enrollees who had a date of death recorded in SSA's DMF but not in the State agency's eligibility system; $293,890 (Federal share) of capitation payments made on behalf of deceased enrollees who had a date of death recorded in SSA's DMF and in the State agency's eligibility system; and $2,208,950 (Federal share) in other Medicaid expenditures that the State agency had previously overreported.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $6,012,198
- Last Update Received
- 03/23/2026
- Next Update Expected
- 09/23/2026
- Legislative Related
- No
25-A-07-044.02We recommend that the Colorado Department of Health Care Policy and Financing identify and recover unallowable capitation payments made to MCOs during our audit period on behalf of deceased enrollees who did not have a date of death recorded in the State agency's eligibility system but who did have a date of death recorded in the DMF, which we estimate to be at least $6,737,760.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $6,737,760
- Last Update Received
- 03/23/2026
- Next Update Expected
- 09/23/2026
- Legislative Related
- No
25-A-07-044.03We recommend that the Colorado Department of Health Care Policy and Financing recover unallowable capitation payments totaling $582,406 that were made to MCOs during our audit period on behalf of deceased enrollees who did have a date of death recorded in the State agency's eligibility system.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $582,406
- Last Update Received
- 03/23/2026
- Next Update Expected
- 09/23/2026
- Legislative Related
- No
25-A-07-044.04We recommend that the Colorado Department of Health Care Policy and Financing identify and recover unallowable capitation payments made on behalf of deceased enrollees after our audit period and repay the Federal share of any amounts recovered.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- -
- Last Update Received
- 03/23/2026
- Next Update Expected
- 09/23/2026
- Legislative Related
- No
25-A-07-044.05We recommend that the Colorado Department of Health Care Policy and Financing strengthen internal controls, to include strengthening policies and procedures on identifying and verifying date-of-death information, so that the State agency's eligibility system is updated based on information provided by data sources, and that capitation payments that have been made on behalf of verified deceased enrollees are recovered.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/10/2025
- Legislative Related
- No
25-A-07-044.06We recommend that the Colorado Department of Health Care Policy and Financing strengthen policies and procedures for the accurate reporting of all Medicaid expenditures to CMS, to include strengthening the State agency's procedures for the routine reconciliation of information provided by the State agency's fiscal data vendor, so that only actually incurred Medicaid expenditures are reported on the Forms CMS-64 to CMS.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 03/23/2026
- Next Update Expected
- 09/23/2026
- Legislative Related
- No
-
Not All Medicare Enrollees Are Continuing Treatment for Opioid Use Disorder
25-E-02-013.01CMS should educate Medicare providers about Medicare services that help enrollees continue treatment for opioid use disorder.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/02/2025
- Next Update Expected
- 09/11/2026
- Legislative Related
- No
25-E-02-013.02CMS should educate Medicare enrollees about Medicare services that help enrollees continue treatment for opioid use disorder.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 02/25/2026
- Next Update Expected
- 03/18/2027
- Legislative Related
- No
25-E-02-013.03CMS should assess and make changes, as appropriate, to the bundled payment codes for office-based treatment to ensure they meet provider and enrollee needs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 07/07/2025
- Next Update Expected
- 07/08/2026
- Legislative Related
- No
25-E-02-013.04CMS should inform providers of emergency department services about the Medicare payment for the initiation of medication for the treatment of opioid use disorder and connecting patients to ongoing care.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/02/2025
- Next Update Expected
- 09/11/2026
- Legislative Related
- No
-
Medicare Improperly Paid Suppliers for Intermittent Urinary Catheters
25-A-09-042.01We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to recover $11,399 in overpayments made to suppliers for the 15 sample items that did not meet Medicare requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $11,399
- Last Update Received
- -
- Closed Date
- 09/05/2025
- Legislative Related
- No
25-A-09-042.02We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to perform additional medical reviews of claims for intermittent urinary catheters and sterile catheter kits, which could have saved Medicare an estimated $35,079,833 for our audit period.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $35,079,833
- Last Update Received
- 09/09/2025
- Next Update Expected
- 03/09/2026
- Legislative Related
- No
25-A-09-042.03We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to provide additional education to suppliers on documenting eligibility for intermittent urinary curved-tip catheters and sterile catheter kits and on documenting refills of catheters and sterile catheter kits.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/16/2025
- Legislative Related
- No
-
West Virginia Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs
25-A-07-043.01We recommend that the West Virginia Bureau for Medical Services refund to the Federal Government $2,159,071 (Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $2,159,071
- Last Update Received
- 04/13/2026
- Next Update Expected
- 10/13/2026
- Legislative Related
- No
25-A-07-043.02We recommend that the West Virginia Bureau for Medical Services refund to the Federal Government $14,514 (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
- Partial Concur
- Potential Savings
- $14,514
- Last Update Received
- -
- Closed Date
- 04/13/2026
- Legislative Related
- No
25-A-07-043.03We recommend that the West Virginia Bureau for Medical Services work with CMS to determine the unallowable portion of $488,185 (Federal share) for other claims for multiple-source physician-administered drugs that may have been ineligible for Federal reimbursement, refund that amount, and consider invoicing drug manufacturers for rebates for these drugs if CMS determines that the drug claims are allowable.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $488,185
- Last Update Received
- 04/13/2026
- Next Update Expected
- 10/13/2026
- Legislative Related
- No
25-A-07-043.04We recommend that the West Virginia Bureau for Medical Services strengthen internal controls for non-crossover claims going forward, to better use collected data to invoice manufacturers and collect rebates for all eligible physician-administered drugs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- -
- Last Update Received
- 04/13/2026
- Next Update Expected
- 10/13/2026
- Legislative Related
- No
25-A-07-043.05We recommend that the West Virginia Bureau for Medical Services consider revising its payment methodology going forward regarding payments for crossover claims, thereby allowing collection of manufacturers' rebates for associated physician-administered drugs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- -
- Last Update Received
- 04/13/2026
- Next Update Expected
- 10/13/2026
- Legislative Related
- No
-
Wisconsin Medicaid Fraud Control Unit: 2024 Inspection
25-E-07-012.01Establish an MOU with DCI to ensure that special agents are supervised in accordance with Federal requirements.- Status
- Closed Acceptable Alternative
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/18/2025
- Legislative Related
- No
25-E-07-012.02Implement a comprehensive case management system that allows the Unit to efficiently access and maintain case information and performance data.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/25/2025
- Legislative Related
- No
25-E-07-012.03Establish policies and procedures to help ensure that case files are maintained effectively.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/25/2025
- Legislative Related
- No
25-E-07-012.04Ensure that supervisory reviews and supervisory approvals to open cases are consistently documented in accordance with Unit policy.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/18/2025
- Legislative Related
- No
25-E-07-012.05Establish written policies for deconflicting cases with Federal partners.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/18/2025
- Legislative Related
- No
25-E-07-012.06Take steps to report all convictions and adverse actions to Federal partners within the appropriate timeframes.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/18/2025
- Legislative Related
- No
25-E-07-012.07Revise its MOU with the State Medicaid agency to reflect applicable legal requirements.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/18/2025
- Legislative Related
- No
-
How FDA Used Its Accelerated Approval Pathway Raised Concerns in 3 of 24 Drugs Reviewed
25-E-01-010.01FDA should define specific factors that would require FDA's accelerated approval council to advise on certain drug applications.- Status
- Open Unimplemented
- Responsible Agency
- FDA
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 04/23/2026
- Next Update Expected
- 09/22/2026
- Legislative Related
- No
25-E-01-010.02FDA should take steps to ensure appropriate documentation of meetings with sponsors in drug approval administrative files.- Status
- Open Unimplemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/23/2026
- Next Update Expected
- 09/22/2026
- Legislative Related
- No
-
Medicare Could Save Billions With Comparable Access for Enrollees if Critical Access Hospital Payments for Swing-Bed Services Were Similar to Those of the Fee-for-Service Prospective Payment System
25-A-05-036.01We recommend that CMS seek a legislative change that will allow it to reimburse CAHs at rates that align with those paid to alternative facilities when it determines that similar care is available at alternative facilities.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $7,710,443,385
- Last Update Received
- 06/30/2025
- Next Update Expected
- 12/30/2025
- Legislative Related
- No
-
Florida Did Not Comply With Federal Waiver and State Requirements at 18 of 20 Adult Day Care Facilities Reviewed
25-A-04-035.01We recommend that the Florida Agency for Health Care Administration ensure that providers correct the 120 instances of provider noncompliance identified in this report.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/01/2026
- Next Update Expected
- 10/01/2026
- Legislative Related
- No
25-A-04-035.02We recommend that the Florida Agency for Health Care Administration improve its oversight and monitoring of providers.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/01/2026
- Next Update Expected
- 10/01/2026
- Legislative Related
- No
25-A-04-035.03We recommend that the Florida Agency for Health Care Administration work with providers to improve their facilities, staffing, and training.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/01/2026
- Next Update Expected
- 10/01/2026
- Legislative Related
- No
-
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That UCare Minnesota (Contract H2459) Submitted to CMS
25-A-07-034.01We recommend that UCare Minnesota refund to the Federal Government the $4,761,271 of estimated net overpayments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $4,761,271
- Last Update Received
- 04/24/2026
- Next Update Expected
- 10/27/2026
- Legislative Related
- No
25-A-07-034.02We recommend that UCare Minnesota identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before or after our audit period and refund any resulting overpayments to the Federal Government.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/24/2026
- Next Update Expected
- 10/27/2026
- Legislative Related
- No
25-A-07-034.03We recommend that UCare Minnesota continue its examination of its existing compliance procedures to identify areas where improvements can be made to ensure that diagnoses that are at high risk for being miscoded comply with Federal requirements (when submitted to CMS for use in CMS's risk adjustment program) and take the necessary steps to enhance those procedures.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/24/2026
- Next Update Expected
- 10/27/2026
- Legislative Related
- No
-
Medicare Advantage Compliance Audit of Specific Diagnosis Codes Blue Care Network of Michigan (Contract H5883) Submitted to CMS
25-A-06-033.01We recommend that Blue Care Network of Michigan refund to the Federal Government the $3,412,369 of estimated overpayments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $3,412,369
- Last Update Received
- 04/15/2026
- Next Update Expected
- 03/24/2026
- Legislative Related
- No
25-A-06-033.02We recommend that Blue Care Network of Michigan identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before or after our audit period and refund any resulting overpayments to the Federal Government.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/15/2026
- Next Update Expected
- 03/24/2026
- Legislative Related
- No
25-A-06-033.03We recommend that Blue Care Network of Michigan continue to examine its existing compliance procedures to identify areas where improvements can be made to ensure that diagnosis codes that are at high risk for being miscoded comply with Federal requirements (when submitted to CMS for use in CMS's risk adjustment program) and take the necessary steps to enhance those procedures.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/15/2026
- Next Update Expected
- 03/24/2026
- Legislative Related
- No
-
ICAP at Columbia University Generally Managed Its PEPFAR Expenditures Appropriately but Lacked a Robust Financial Management System
25-A-04-032.01We recommend that ICAP refund $58,111 to CDC for transactions that it could not adequately support.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- $58,111
- Last Update Received
- -
- Closed Date
- 02/05/2026
- Legislative Related
- No
25-A-04-032.02We recommend that ICAP fully implement its new grants management system, which will allow it to track and record its PEPFAR expenditures by CoAg and award year; and maintain supporting documentation for expenditures contained in its accounting records.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/29/2025
- Legislative Related
- No
-
Medicare Home Health Agency Provider Compliance Audit: Bridge Home Health
25-A-05-031.01We recommend that Bridge Home Health refund the $6,046 in overpayments to the Medicare program.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $6,046
- Last Update Received
- -
- Closed Date
- 07/03/2025
- Legislative Related
- No
25-A-05-031.02We recommend that Bridge Home Health identify similar instances of noncompliance that occurred before, during, and after the audit period and determine the impact and return any overpayments to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/03/2025
- Legislative Related
- No
25-A-05-031.03We recommend that Bridge Home Health strengthen its review of medical record documentation to ensure compliance with Medicare billing requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/17/2025
- Legislative Related
- No
-
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Triple-S Advantage, Inc., (Contract H5774) Submitted to CMS
25-A-04-030.01We recommend that Triple-S Advantage, Inc. refund to the Federal Government $296,758 in net overpayments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $296,758
- Last Update Received
- 04/28/2026
- Next Update Expected
- 03/30/2026
- Legislative Related
- No
25-A-04-030.02We recommend that Triple-S Advantage, Inc. identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before or after our audit period and refund any resulting overpayments to the Federal Government.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/28/2026
- Next Update Expected
- 03/30/2026
- Legislative Related
- No
25-A-04-030.03We recommend that Triple-S Advantage, Inc. continue to examine its existing compliance procedures to identify areas where improvements can be made to ensure that diagnosis codes that are at high risk of being miscoded comply with Federal requirements (when submitted to CMS for use in CMS's risk adjustment program) and take the necessary steps to enhance those procedures.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/28/2026
- Next Update Expected
- 03/30/2026
- Legislative Related
- No
-
Some Selected Skilled Nursing Facilities Did Not Comply With Medicare Requirements for Reporting Related-Party Costs
25-A-07-028.01We recommend that the Centers for Medicare & Medicaid services require the MACs to include, as part of the normal desk review or audit process, a review of reporting and disclosure of related-party costs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 05/12/2025
- Next Update Expected
- 11/12/2025
- Legislative Related
- No
25-A-07-028.02We recommend that the Centers for Medicare & Medicaid Services develop and implement guidance for skilled nursing facilities on the appropriate methods for providers to determine their allowable related-party costs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/17/2025
- Legislative Related
- No
25-A-07-028.03We recommend that the Centers for Medicare & Medicaid Services provide guidance to reeducate Medicare Administrative Contractors on the need to review, grant, and document requests from skilled nursing facilities for exceptions to cost reporting requirements in compliance with 42 CFR § 413.17(d).- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/17/2025
- Legislative Related
- No
-
Some HHS Requirements for Vetting Mobile Apps Were Not Followed Prior to the Release of the AHRQ Question Builder App
25-A-18-027.01We recommend that the Agency for Healthcare Research and Quality reassess the Question Builder app to determine if the unnecessary functionality and privileges built into the app can and should be removed or formally assess, document, and accept the risk of not removing them.- Status
- Open Unimplemented
- Responsible Agency
- AHRQ
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/16/2025
- Legislative Related
- No
25-A-18-027.02We recommend that the Agency for Healthcare Research and Quality update the AHRQ Mobile Application Development Policy to require project officers and app developers to assess AHRQ mobile apps for unnecessary or unused functionality and remove or disable such functionality where feasible before submitting it to an app store and establish a procedure to ensure adherence to these requirements.- Status
- Open Unimplemented
- Responsible Agency
- AHRQ
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/16/2025
- Legislative Related
- No
25-A-18-027.03We recommend that the Agency for Healthcare Research and Quality update the AHRQ Mobile Application Development Policy to require vetting the security of all AHRQ mobile apps for compliance with the HHS secure coding policy requirements and correcting any security vulnerabilities identified before releasing a mobile app to app stores for public use and establish a procedure to ensure adherence to these requirements- Status
- Open Unimplemented
- Responsible Agency
- AHRQ
- Response
- Overdue
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 06/16/2025
- Legislative Related
- No