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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 November 15, 2024
1,310
Unimplemented
recommendations
$270.4B
Potential savingsfrom unimplemented recommendations
2,698
Implemented and Closed
recommendations since FY 2017
Views
OIG Recommendations Grouped by Report
Showing 361–380 of 1,223 reports, containing 4,008 recommendations
Sorted by latest release date
-
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That UPMC Health Plan, Inc. (Contract H3907) Submitted to CMS
22-A-07-011.01Refund to the Federal Government the $6,401,297 of estimated net overpayments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $6,401,297
- Last Update Received
- 09/17/2024
- Next Update Expected
- 03/17/2025
- Legislative Related
- No
22-A-07-011.02Identify, 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
- 09/17/2024
- Next Update Expected
- 03/17/2025
- Legislative Related
- No
22-A-07-011.03Continue its examination of existing compliance procedures to identify areas where improvements can be made to ensure 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
- 09/17/2024
- Next Update Expected
- 03/17/2025
- Legislative Related
- No
-
The District of Columbia's Monitoring Did Not Ensure Child Care Provider Compliance With Criminal Background Check Requirements at 7 of 30 Providers Reviewed
22-A-03-010.01Continue to take actions to pursue Notice of Suitability Letters for all individuals identified, and, specifically, conduct all required child abuse and neglect background checks for the three individuals we reviewed who did not have the required checks at the time of our review and whose background checks were not resolved during our audit.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/21/2023
- Legislative Related
- No
22-A-03-010.02Work with District legislators to enable CFSA to send Child Protection Register background check results directly to the State agency without requiring a signed and notarized consent form from the individual whose records are to be released.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/21/2023
- Legislative Related
- Yes
22-A-03-010.03Remind its child care licensing specialists to follow up with child care providers to ensure all Child Protection Register background check results are uploaded to the provider's Facility Profile page in the Division of Early Learning Licensing Tool in a timely manner.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/21/2023
- Legislative Related
- No
-
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Coventry Health Care of Missouri, Inc. (Contract H2663) Submitted to CMS
22-A-07-008.01We recommend that Coventry Health Care of Missouri, Inc. refund to the Federal Government the $548,852 of total net overpayments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $548,852
- Last Update Received
- 09/18/2024
- Next Update Expected
- 04/02/2025
- Legislative Related
- No
22-A-07-008.02We recommend that Coventry Health Care of Missouri, Inc. identify, for the diagnoses included in this report, instances of noncompliance in the enrollee-years that occurred: (1) during our audit period but were not included in our judgmental sample and (2) before and 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
- 09/18/2024
- Next Update Expected
- 04/02/2025
- Legislative Related
- No
22-A-07-008.03We recommend that Coventry Health Care of Missouri, Inc. enhance its compliance procedures to focus on diagnosis codes that are at high risk for being miscoded by 1) educating its providers about the proper use and documentation of these diagnoses and 2) determining whether these diagnosis codes (when submitted to CMS for use in CMS's risk adjustment program) comply with Federal requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/18/2024
- Next Update Expected
- 04/02/2025
- Legislative Related
- No
-
Tennessee Medicaid Claimed Hundreds of Millions of Federal Funds for Certified Public Expenditures That Were Not in Compliance With Federal Requirements
22-A-04-005.01We recommend that the Tennessee State Medicaid Agency refund to the Federal Government $397,341,616 in overpayments representing the Federal share of CPEs that the State agency claimed in excess of the allowable amount.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $397,341,616
- Last Update Received
- 10/30/2024
- Next Update Expected
- 05/01/2025
- Legislative Related
- No
22-A-04-005.02We recommend that the Tennessee State Medicaid Agency provide support for or refund to the Federal Government $370,119,499 for the net costs of caring for uninsured IMD patients for which the State agency did not provide detailed supporting documentation.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $370,119,499
- Last Update Received
- 10/30/2024
- Next Update Expected
- 05/01/2025
- Legislative Related
- No
22-A-04-005.03We recommend that the Tennessee State Medicaid Agency establish additional policies and procedures to ensure compliance with the STCs including policies and procedures for adjusting the CPE estimates to actual costs on the CMS-64s upon determining that hospitals have been overpaid or underpaid.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 10/30/2024
- Next Update Expected
- 05/01/2025
- Legislative Related
- No
22-A-04-005.04We recommend that the Tennessee State Medicaid Agency establish additional policies and procedures to ensure compliance with the STCs including policies and procedures for collecting and maintaining patient-level detail data for the uninsured population for the IMDs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 02/28/2022
- Next Update Expected
- 10/19/2022
- Legislative Related
- No
22-A-04-005.05We recommend that the Tennessee State Medicaid Agency establish additional policies and procedures to ensure compliance with the STCs including policies and procedures for ensuring that the State agency identifies and excludes from its actual CPE calculations the net costs of caring for IMD patients between the ages of 21 and 64.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 10/30/2024
- Next Update Expected
- 05/01/2025
- Legislative Related
- No
22-A-04-005.06We recommend that the Tennessee State Medicaid Agency establish additional policies and procedures to ensure compliance with the STCs including policies and procedures for reviewing the actual CPE calculations of its contractor.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 02/28/2022
- Next Update Expected
- 10/19/2022
- Legislative Related
- No
-
More Than One-Third of Medicaid-Enrolled Children in Five States Did Not Receive Required Blood Lead Screening Tests
22-E-07-001.01CMS should monitor national EPSDT performance data for blood lead screening tests and target efforts toward low-performing States to develop action plans for increasing tests, according to Medicaid's schedule.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 05/02/2024
- Next Update Expected
- 05/15/2025
- Legislative Related
- No
22-E-07-001.02CMS should ensure consistency across CMS guidance related to actionable blood lead reference values and blood lead screening test definitions.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 05/02/2024
- Next Update Expected
- 05/15/2025
- Legislative Related
- No
22-E-07-001.03CMS should coordinate with partners to develop and disseminate to State Medicaid agencies educational materials that reaffirm requirements and schedules for blood lead screening tests.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 05/02/2024
- Next Update Expected
- 05/15/2025
- Legislative Related
- No
-
Medicare Overpaid $636 Million for Neurostimulator Implantation Surgeries
22-A-01-001.01We recommend that the Centers for Medicare & Medicaid Services instruct the Medicare contractors to recover the portion of the $1,205,654 in identified Medicare potential overpayments from the 46 providers for the 54 incorrectly billed claims attributed to 48 sampled beneficiaries that are within the 4-year reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $1,205,654
- Last Update Received
- -
- Closed Date
- 04/05/2022
- Legislative Related
- No
22-A-01-001.02We recommend that the Centers for Medicare & Medicaid Services instruct the Medicare contractors to instruct the 46 providers identified with the 54 incorrectly billed claims to refund $115,206 in coinsurance amounts that have been incorrectly collected from the 48 sampled beneficiaries, or from someone on their behalf, for claims within the 4-year reopening period.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $115,206
- Last Update Received
- -
- Closed Date
- 04/05/2022
- Legislative Related
- No
22-A-01-001.03We recommend that the Centers for Medicare & Medicaid Services instruct the Medicare contractors to determine which of the remaining 58,107 claims in our sampling frame were incorrectly billed, recover the portion of the estimated $636,498,597 in potential Medicare overpayments that are within the 4-year reopening period, and instruct the providers identified with the incorrectly billed clams to refund $54,041,129 in beneficiary coinsurance amounts.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $636,498,597
- Last Update Received
- -
- Closed Date
- 08/23/2022
- Legislative Related
- No
22-A-01-001.04We recommend that the Centers for Medicare & Medicaid Services instruct the Medicare contractors to instruct the providers identified with the incorrectly billed clams to refund $54,041,129 in beneficiary coinsurance amounts.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $54,041,129
- Last Update Received
- -
- Closed Date
- 10/04/2022
- Legislative Related
- No
22-A-01-001.05We recommend that the Centers for Medicare & Medicaid Services instruct the Medicare contractors to based on the results of this audit, notify appropriate providers (i.e., those for whom CMS determines this audit constitutes credible information of potential overpayments), so they can exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/05/2022
- Legislative Related
- No
22-A-01-001.06We also recommend that the Centers for Medicare & Medicaid Services conduct provider outreach and education regarding the Medicare coverage requirements for neurostimulator implantation surgeries.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/17/2022
- Legislative Related
- No
22-A-01-001.07We recommend that CMS evaluate the impact of its new prior authorization requirement and, if appropriate, consider extending the requirement to neurostimulator implantation surgeries for Parkinson's disease and seizure disorders.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/23/2022
- Legislative Related
- No
-
SAMHSA's Oversight Generally Ensured That the Commission on Accreditation of Rehabilitation Facilities Verified That Opioid Treatment Programs Met Federal Opioid Treatment Standards
22-A-09-002.01We recommend that the Substance Abuse and Mental Health Services Administration update its policies and procedures to require verification that accreditation bodies maintain records that contain sufficient detail to support each accreditation decision.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/20/2022
- Legislative Related
- No
-
Case Study: Missouri's Efforts To Protect Children Missing From Foster Care
21-E-07-045.01Missouri foster care agency should develop policies to help identify (a) children who have a heightened risk of going missing from care and (b) interventions that could reduce their risk.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/06/2023
- Next Update Expected
- 12/11/2024
- Legislative Related
- No
21-E-07-045.02Missouri foster care agency should implement a monitoring mechanism to ensure that case managers comply with requirements and document their compliance when children are identified as missing and when they are located or return to care.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/06/2023
- Next Update Expected
- 12/11/2024
- Legislative Related
- No
21-E-07-045.03Missouri foster care agency should implement improvements to the case management system to enable accurate identification of children who are missing from care.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/14/2022
- Legislative Related
- No
21-E-07-045.04ACF should develop a forum for States to share experiences and best practices related to the following: reducing children's risk for going missing from foster care, locating missing children, and addressing their needs after they return to care.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 11/14/2023
- Next Update Expected
- 12/11/2024
- Legislative Related
- No
21-E-07-045.05ACF should support Missouri as it works to reduce children's risk for going missing from foster care and to improve compliance with Federal and State requirements related to children who go missing.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 11/14/2023
- Next Update Expected
- 12/11/2024
- Legislative Related
- No
-
Six of Eight Home Health Agency Providers Had Infection Control Policies and Procedures That Complied With CMS Requirements and Followed CMS COVID-19 Guidance To Safeguard Medicare Beneficiaries, Caregivers, and Staff During the COVID-19 Pandemic
21-A-01-161.01We recommend that the Centers for Medicare & Medicaid Services develop and share with the HHA industry information on COVID-19 infection prevention and control best practices that HHA providers can use to comply with CMS requirements and follow CMS guidance.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/07/2022
- Legislative Related
- No
-
California Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities
21-A-09-160.01We recommend that the California Department of Health Care Services, in coordination with the Department of Developmental Services provide additional guidance to providers, such as a standard reporting form that includes the types of incidents that are required to be reported, and provide additional training to providers on critical incident identification and reporting.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/08/2022
- Legislative Related
- No
21-A-09-160.02We recommend that the California Department of Health Care Services, in coordination with the Department of Developmental Services provide additional guidance and training to regional centers for identifying the types of incidents that are required to be reported.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/08/2022
- Legislative Related
- No
21-A-09-160.03We recommend that the California Department of Health Care Services, in coordination with the Department of Developmental Services perform additional analytical procedures, such as data matches, to identify potential critical incidents that have not been reported and follow up on them as required.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/23/2023
- Legislative Related
- No
21-A-09-160.04We recommend that the California Department of Health Care Services, in coordination with the Department of Developmental Services improve oversight to ensure that timeliness and followup requirements related to reported critical incidents are met.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/23/2023
- Legislative Related
- No
21-A-09-160.05We recommend that the California Department of Health Care Services, in coordination with the Department of Developmental Services ensure that reported critical incidents involving the death of a beneficiary are reviewed by a mortality review committee as appropriate.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/08/2022
- Legislative Related
- No
-
About Seventy-Nine Percent of Opioid Treatment Program Services Provided to Medicaid Beneficiaries in Colorado Did Not Meet Federal and State Requirements
21-A-07-159.01We recommend that the Colorado Department of Health Care Policy and Financing work with the Colorado Department of Human Services to strengthen its biennial audits of OTPs to ensure that services provided are in accordance with Federal and State requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/02/2022
- Legislative Related
- No
21-A-07-159.02We recommend that the Colorado Department of Health Care Policy and Financing work with the Colorado Department of Human Services to provide technical assistance to OTPs to ensure that the providers maintain adequate recordkeeping systems.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/02/2022
- Legislative Related
- No
21-A-07-159.03We recommend that the Colorado Department of Health Care Policy and Financing work with the Colorado Department of Human Services to educate OTPs on the deficiencies we identified in this report to increase their awareness of compliance issues regarding Federal and State requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/02/2022
- Legislative Related
- No
-
States Reported Multiple Challenges With Using Telehealth To Provide Behavioral Health Services to Medicaid Enrollees
21-E-02-041.01CMS should share information to help States address challenges with using telehealth to provide behavioral health services to Medicaid enrollees.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 03/17/2022
- Next Update Expected
- 03/17/2023
- Legislative Related
- No
-
Opportunities Exist To Strengthen Evaluation and Oversight of Telehealth for Behavioral Health in Medicaid
21-E-02-044.01CMS should ensure that the three States that are unable to distinguish telehealth from in-person services implement indicators to identify which services are provided via telehealth.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/26/2024
- Legislative Related
- No
21-E-02-044.02CMS should conduct evaluations, and support State efforts to evaluate the effects of telehealth on access, cost, and quality of behavioral health services.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 10/03/2024
- Next Update Expected
- 05/15/2025
- Legislative Related
- No
21-E-02-044.03CMS should conduct monitoring for fraud, waste, and abuse, and support State efforts to oversee telehealth for behavioral health services.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 12/06/2023
- Next Update Expected
- 05/15/2025
- Legislative Related
- No
-
New Mexico Medicaid Fraud Control Unit: 2020 Review
21-E-06-042.01Develop and implement an action plan to reduce turnover of management and staff and to ensure continuity of Unit operations should turnover occur- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/07/2022
- Next Update Expected
- 03/17/2023
- Legislative Related
- No
21-E-06-042.02Develop and implement an action plan to ensure that the Unit receives adequate quality referrals of fraud and patient abuse or neglect- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/28/2022
- Legislative Related
- No
21-E-06-042.03Ensure that investigations are completed within the appropriate timeframes and that delays are documented in the case files- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/28/2022
- Legislative Related
- No
21-E-06-042.04Improve communication and seek more opportunities to investigate cases jointly with Federal partners- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/28/2022
- Legislative Related
- No
21-E-06-042.05Ensure that supervisory reviews of case files are conducted periodically and documented in accordance with Unit policy- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/28/2022
- Legislative Related
- No
21-E-06-042.06Ensure that all convictions and adverse actions are reported to Federal partners within the appropriate timeframes- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/07/2022
- Next Update Expected
- 03/17/2023
- Legislative Related
- No
21-E-06-042.07Revise the Unit's MOU with the State Medicaid agency to establish procedures by which the Unit will receive referrals of potential fraud from MCOs- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/07/2022
- Next Update Expected
- 03/17/2023
- Legislative Related
- No
21-E-06-042.08Ensure that costs associated with non-MFCU activities are excluded from the Unit's Federal reimbursement request- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/07/2022
- Next Update Expected
- 03/17/2023
- Legislative Related
- No
-
Indian Health Service Use of Critical Care Response Teams Has Helped To Meet Facility Needs During the COVID-19 Pandemic
21-E-06-043.01IHS should solicit feedback from CCRTs regarding their observations of potential need for broader IHS-wide improvements.- Status
- Open Unimplemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 10/05/2023
- Next Update Expected
- 11/06/2024
- Legislative Related
- No
21-E-06-043.02IHS should compile the CCRTs' recommendations to individual facilities and share them across all IHS and Tribal facilities.- Status
- Open Unimplemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 10/05/2023
- Next Update Expected
- 11/06/2024
- Legislative Related
- No
21-E-06-043.03IHS should assess whether IHS could use the CCRT model to provide support and training to facilities needing assistance with non-COVID-19-related care.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/06/2023
- Legislative Related
- No
-
Some Medicare Advantage Companies Leveraged Chart Reviews and Health Risk Assessments To Disproportionately Drive Payments
21-E-03-040.01CMS should provide oversight of the 20 Medicare Advantage (MA) companies that had a disproportionate share of the risk-adjusted payments from chart reviews and health risk assessments (HRAs).- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 01/31/2023
- Next Update Expected
- 02/28/2024
- Legislative Related
- No
21-E-03-040.02CMS should take additional actions to determine the appropriateness of payments and care for the one MA company that substantially drove risk-adjusted payments from chart reviews and HRAs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 02/13/2023
- Next Update Expected
- 02/28/2024
- Legislative Related
- No
21-E-03-040.03CMS should perform periodic monitoring to identify MA companies that had a disproportionate share of risk-adjusted payments from chart reviews and HRAs.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 01/31/2023
- Next Update Expected
- 02/28/2024
- Legislative Related
- No
-
Colorado Did Not Invoice Rebates to Manufacturers for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations
21-A-07-156.01We recommend that the Colorado Department of Health Care Policy and Financing work with CMS to determine the total amount of claims that were eligible for rebates as well as the unallowable portion of the physician-administered drug claims, invoice drug manufacturers for the calculated rebates, and refund the Federal share of rebates collected for the years covered by our audit period and for years after our audit period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- Legislative Related
- No
21-A-07-156.02We recommend that the Colorado Department of Health Care Policy and Financing develop and implement policies and procedures to ensure that all eligible physician-administered drugs, including those dispensed to MCO enrollees, are invoiced for rebate.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/23/2024
- Legislative Related
- No
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South Carolina Medicaid Fraud Control Unit: 2020 Inspection
21-E-12-039.01Assess the adequacy of existing staffing levels, and if appropriate, consider a plan to expand the size of the Unit- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/02/2022
- Legislative Related
- No
21-E-12-039.02Take steps to reduce investigative delays and ensure that delays are documented in the case management system.- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/17/2022
- Legislative Related
- No
21-E-12-039.03Seek approval from the South Carolina Office of the Attorney General to implement a new case management system- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/02/2022
- Legislative Related
- No
21-E-12-039.04Take steps to ensure that supervisory reviews of Unit case files are conducted periodically and documented in accordance with Unit policy- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/17/2022
- Legislative Related
- No
21-E-12-039.05Take steps to ensure that all convictions and adverse actions are reported to Federal partners within the appropriate timeframes- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/18/2022
- Next Update Expected
- 03/06/2022
- Legislative Related
- No
21-E-12-039.06Revise the Unit's MOU with the State Medicaid agency to establish procedures by which the Unit will receive referrals of potential fraud from managed care organizations- Status
- Open Unimplemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/28/2022
- Next Update Expected
- 03/06/2022
- Legislative Related
- No
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An Ophthalmology Clinic in Florida: Audit of Medicare Payments for Eye Injections of Avastin, Eylea, and Lucentis
21-A-09-155.01We recommend that the Clinic refund to First Coast $215,606 in estimated overpayments for other services provided on the same day as intravitreal injections of Avastin, Eylea, and Lucentis.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $215,606
- Last Update Received
- -
- Closed Date
- 08/10/2022
- Legislative Related
- No
21-A-09-155.02We recommended that the Clinic exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/18/2022
- Legislative Related
- No
21-A-09-155.03We recommended that the Clinic implement policies and procedures to ensure that it does not bill for services that are not separately payable from intravitreal injections of Avastin, Eylea, and Lucentis.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/27/2022
- Legislative Related
- No
21-A-09-155.04We recommended that the Clinic implement policies and procedures to ensure that it bills only for services that are reasonable and necessary.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 01/27/2022
- Legislative Related
- No
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Kansas Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths
21-A-07-153.01We recommend that the State agency refund $10,930,063 to the Federal Government, consisting of $1,496,725 (Federal share) of capitation payments made on behalf of deceased beneficiaries who had a date of death recorded in the KEES, $8,264,519 (Federal share) of capitation payments made on behalf of deceased beneficiaries who did not have a date of death recorded in the KEES but who did have a date of death recorded in the DMF, and $1,168,819 (Federal share) in overreported Medicaid expenditures that were related to prior-period adjustments.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $10,930,063
- Last Update Received
- 04/02/2024
- Next Update Expected
- 03/24/2025
- Legislative Related
- No
21-A-07-153.02We recommend the State agency recover unallowable capitation payments totaling $2,667,316 that were made to MCOs during our audit period on behalf of deceased beneficiaries who did have a date of death recorded in the KEES.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/02/2024
- Next Update Expected
- 03/24/2025
- Legislative Related
- No
21-A-07-153.03We recommend that the State agency identify and recover unallowable capitation payments made to MCOs during our audit period on behalf of deceased beneficiaries who did not have a date of death recorded in the KEES but who did have a date of death recorded in the DMF, which we estimate to be at least $14,648,662.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/02/2024
- Next Update Expected
- 03/24/2025
- Legislative Related
- No
21-A-07-153.04We recommend that the State agency identify and recover unallowable capitation payments made on behalf of deceased beneficiaries before and after our audit period and repay the Federal share of any amounts recovered.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 04/02/2024
- Next Update Expected
- 03/24/2025
- Legislative Related
- No
21-A-07-153.05We recommend that the State agency strengthen internal controls, to include strengthening policies and procedures and enhancing training on the research and application of date-of-death information and other eligibility data, to ensure that the State agency's KEES is accurately updated based on information provided by Federal data sources, that the KEES generates tasks to update eligibility status of deceased beneficiaries, and that all eligibility update tasks are completed in a timely manner by State agency staff.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/26/2024
- Next Update Expected
- 03/24/2025
- Legislative Related
- No
21-A-07-153.06We recommend that the State agency strengthen policies and procedures for the accurate reporting of all Medicaid expenditures, to include prior-period adjustments, to CMS.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/26/2024
- Next Update Expected
- 03/24/2025
- Legislative Related
- No