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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—a subset that we think, if implemented, would have the most impact (learn more). Notable differences from our previous Top Unimplemented Recommendations report include:
- The list is comprised of individual recommendations from OIG reports, not rolled up by topic.
- No arbitrary cap is imposed on the number of recommendations included.
- Status updates as recommendations are implemented.
Summary of All Recommendations
Updated Monthly · Last updated on April 17, 2025
1,213
Unimplemented
recommendations
2,931
Implemented and Closed
recommendations since FY 2017
Views
OIG Recommendations Grouped by Report
Showing 1–20 of 1,267 reports, containing 4,144 recommendations
Sorted by latest release date
-
Ohio Did Not Comply With Federal Waiver and State Requirements at 18 of 19 Adult Day Care Facilities Audited
25-A-05-061.01We recommend that the Ohio Department of Medicaid ensure providers correct the 117 instances of provider noncompliance identified in this report.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 10/09/2025
- Legislative Related
- No
25-A-05-061.02We recommend that the Ohio Department of Medicaid improve its oversight and monitoring of all providers.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 10/09/2025
- Legislative Related
- No
25-A-05-061.03We recommend that the Ohio Department of Medicaid work with providers to improve their facilities, staffing, and training.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 10/09/2025
- Legislative Related
- No
-
Most Institutions That Received NIH Funding Did Not Fully Understand When They Must Report Monetary Donations
25-E-03-023.01NIH should clarify for NIH-funded institutions which monetary donations they must report to NIH as other support.- Status
- Open Unimplemented
- Responsible Agency
- NIH
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 09/29/2025
- Legislative Related
- No
-
SAMHSA’s FindTreatment.gov Contained Some Inaccurate Information on Substance Use and Mental Health Treatment Facilities
25-A-09-057.01We recommend that the Substance Abuse and Mental Health Services Administration work with the Contractor to strengthen procedures related to verifying facility information, such as validating a sample of facilities each year.- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 09/18/2025
- Legislative Related
- No
25-A-09-057.02We recommend that the Substance Abuse and Mental Health Services Administration improve the prominence of the statement on FindTreatment.gov about contacting the Contractor to report an issue with the information listed for a facility, such as placing the statement at the top of the page on the website and using a larger font size and a different color.- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 09/18/2025
- Legislative Related
- No
25-A-09-057.03We recommend that the Substance Abuse and Mental Health Services Administration work with the Contractor to implement additional system edits in the Survey to prevent facilities from submitting the Survey without completing all of the critical information fields.- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 09/18/2025
- Legislative Related
- No
-
Medicare Administrative Contractors Did Not Consistently Meet Medicare Cost Report Oversight Requirements
25-A-04-056.01We recommend that the Centers for Medicare & Medicaid Services provide MACs with a thorough explanation of the QASP results.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 09/17/2025
- Legislative Related
- No
25-A-04-056.02We recommend that the Centers for Medicare & Medicaid Services update the audit program to incorporate revised change requests and TDLs so MACs can obtain a better understanding of CMS expectations and be evaluated on current requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 09/17/2025
- Legislative Related
- No
25-A-04-056.03We recommend that the Centers for Medicare & Medicaid Services offer MACs additional training and guidance, based on the results of their QASP, and include best practices used by MACs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 09/17/2025
- Legislative Related
- No
-
State Survey Agencies Need Additional Guidance to Assess Nursing Home Emergency Preparedness Programs
25-E-04-020.01CMS should provide surveyors with instructions for how to assess the contents of nursing home emergency preparedness documentation as a part of the survey process.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 09/09/2025
- Legislative Related
- No
25-E-04-020.02CMS should issue guidance that encourages SAs to collaborate and share information.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 09/09/2025
- Legislative Related
- No
-
Texas Did Not Fully Comply With Federal Waiver and State Health, Safety, and Administrative Requirements at All 20 Adult Day Activity Health and Service Facilities Audited
25-A-06-055.01We recommend that the Texas Department of Health and Human Services ensure that providers correct the 253 instances of provider noncompliance identified in this report.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 09/06/2025
- Legislative Related
- No
25-A-06-055.02We recommend that the Texas Department of Health and Human Services improve oversight and monitoring of providers.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 09/06/2025
- Legislative Related
- No
25-A-06-055.03We recommend that the Texas Department of Health and Human Services work with providers to improve their facilities, staffing, and training.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 09/06/2025
- Legislative Related
- No
-
North Carolina’s Medicaid Control Environment, Risk Management Practices, and Governing Processes Were Assessed as Moderate Risk
25-A-04-054.01We recommend that the North Carolina Department of Health and Human Services, Division of Health Benefits develop mitigating controls and strategies to lower risk within the high- and moderate-rated risk areas we identified.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 09/02/2025
- Legislative Related
- No
-
CDC Lacked Documentation for Its Redirections of PEPFAR Funds to Support the COVID-19 Response
25-A-04-052.01We recommend that the Centers for Disease Control and Prevention: Develop, implement, and maintain a centralized repository to store required documentation pertaining to PEPFAR funds that are redirected due to a pandemic or other emergency.- Status
- Open Unimplemented
- Responsible Agency
- CDC
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/26/2025
- Legislative Related
- No
-
Florida Generally Used CDC Public Health Crisis Response Cooperative Agreement Program Funds in Accordance With Federal Requirements
25-A-02-053.01We recommend that the Florida Department of Health refund $218,504 to the Federal Government.- Status
- Open Unimplemented
- Responsible Agency
- CDC
- Response
- Not Yet Due
- Potential Savings
- $218,504
- Last Update Received
- -
- Next Update Expected
- 08/26/2025
- Legislative Related
- No
25-A-02-053.02We recommend that the Florida Department of Health establish policies and procedures to verify that vendors submit approved timesheets to support the time and effort charged to the cooperative agreement program by contracted employees.- Status
- Open Unimplemented
- Responsible Agency
- CDC
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/26/2025
- Legislative Related
- No
25-A-02-053.03We recommend that the Florida Department of Health strengthen its existing processes for ensuring that Federal closeout reports are accurate and timely submitted.- Status
- Open Unimplemented
- Responsible Agency
- CDC
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/26/2025
- Legislative Related
- No
-
ACF Used Contractor Personnel To Perform Inherently Governmental Functions and Paid Millions in Potentially Unallowable Costs
25-A-12-051.01We recommend that the Administration for Children and Families update its policies and procedures for awarding contracts for other than full and open competition in emergency situations to incorporate FAR requirements for time-and-materials contracts.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 03/20/2025
- Next Update Expected
- 09/27/2025
- Legislative Related
- No
25-A-12-051.02We recommend that the Administration for Children and Families provide training to program officials and contracting staff as appropriate that covers requirements for administering nonpersonal services contracts for professional support services; specifying that contracts must not be used for the performance of inherently governmental functions; providing written consent for the use of subcontractors; reviewing and approving invoices; and maintaining documentation to support costs for services performed.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 03/27/2025
- Next Update Expected
- 09/27/2025
- Legislative Related
- No
25-A-12-051.03We recommend that the Administration for Children and Families update its policies and procedures for receipt and oversight of deliverables and to incorporate Federal requirements related to the: (1) review, approval, and monitoring of invoices and (2) use of CLINs to properly account for and pay contractor expenditures.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 03/27/2025
- Next Update Expected
- 09/27/2025
- Legislative Related
- No
25-A-12-051.04We recommend that the Administration for Children and Families review potentially unallowable costs and obtain supporting documentation or take appropriate action to recoup from Deloitte any improperly paid amounts for $2,022,468 for invoices that did not identify CLINs to track expenses; $1,362,621 in overtime charges; $1,226,649 of labor charges for invoices that did not include specific dates when each employee performed work; $244,174 in nonlabor costs that were not supported by receipts; and $112,945 of unsupported subcontractor charges.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- $4,968,857
- Last Update Received
- 03/27/2025
- Next Update Expected
- 09/27/2025
- Legislative Related
- No
25-A-12-051.05We recommend that the Administration for Children and Families review and correct potential Antideficiency Act violations by deobligating and obligating funds to appropriate CLINs used and report an Antideficiency Act violation if the violation cannot be corrected.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 03/27/2025
- Next Update Expected
- 09/27/2025
- Legislative Related
- No
25-A-12-051.06We recommend that the Administration for Children and Families develop and implement policies and procedures requiring contracts to include FAR clauses related to overtime requirements in contracts and for tracking and verifying that all contractor staff (including subcontractors) assigned to work on a contract complete required trainings before performing any work under the contract (or within the allowed time).- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Partial Concur
- Potential Savings
- -
- Last Update Received
- 03/27/2025
- Next Update Expected
- 09/27/2025
- Legislative Related
- No
-
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 EFTs that were reported in response to OIG's survey.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/24/2025
- 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 EFT fraud.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/24/2025
- 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 EFT fraud schemes.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/24/2025
- 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
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/19/2025
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/19/2025
- 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
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/18/2025
- 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
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/18/2025
- 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
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $21,606,437
- Last Update Received
- -
- Next Update Expected
- 08/18/2025
- 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
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $6,239,386
- Last Update Received
- -
- Next Update Expected
- 08/18/2025
- 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
- Not Yet Due
- Potential Savings
- $13,922,912
- Last Update Received
- -
- Next Update Expected
- 08/18/2025
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/18/2025
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/18/2025
- 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
- Not Yet Due
- Potential Savings
- $6,012,198
- Last Update Received
- -
- Next Update Expected
- 08/13/2025
- 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
- Not Yet Due
- Potential Savings
- $6,737,760
- Last Update Received
- -
- Next Update Expected
- 08/13/2025
- 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
- Not Yet Due
- Potential Savings
- $582,406
- Last Update Received
- -
- Next Update Expected
- 08/13/2025
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/13/2025
- 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
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/13/2025
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/13/2025
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/06/2025
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/06/2025
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/06/2025
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/06/2025
- 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
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $11,399
- Last Update Received
- -
- Next Update Expected
- 08/03/2025
- 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
- Not Yet Due
- Potential Savings
- $35,079,833
- Last Update Received
- -
- Next Update Expected
- 08/03/2025
- 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
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/03/2025
- 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
- Not Yet Due
- Potential Savings
- $2,159,071
- Last Update Received
- -
- Next Update Expected
- 08/03/2025
- 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
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Not Yet Due
- Potential Savings
- $14,514
- Last Update Received
- -
- Next Update Expected
- 08/03/2025
- 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
- Not Yet Due
- Potential Savings
- $488,185
- Last Update Received
- -
- Next Update Expected
- 08/03/2025
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/03/2025
- 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
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 08/03/2025
- 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
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 07/29/2025
- 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
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 07/29/2025
- Legislative Related
- No
25-E-07-012.03Establish policies and procedures to help ensure that case files are maintained effectively- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 07/29/2025
- 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
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 07/29/2025
- Legislative Related
- No
25-E-07-012.05Establish written policies for deconflicting cases with Federal partners- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 07/29/2025
- Legislative Related
- No
25-E-07-012.06Take steps to report all convictions and adverse actions to Federal partners within the appropriate timeframes- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 07/29/2025
- Legislative Related
- No
25-E-07-012.07Revise its MOU with the State Medicaid agency to reflect applicable legal requirements- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Not Yet Due
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- 07/29/2025
- Legislative Related
- No