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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

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OIG's Top Unimplemented Recommendations

Showing 21–33 of 33 recommendations Sorted by oldest release date
  • Centers for Medicare and Medicaid Services
    $128.0M
    Potential Savings

    Medicare Could Have Saved Up To $128 Million Over 5 Years if CMS Had Implemented Controls To Address Duplicate Payments for Services Provided to Individuals With Medicare and Veterans Health Administration Benefits
    23-A-09-066.03
    We recommend that the Centers for Medicare & Medicaid Services establish an internal process (such as system edits) to address duplicate payments made by Medicare for medical services authorized and paid for by VHA, which could have saved Medicare up to $128 million during our audit period.
    $128.0M
    Potential Savings

    Status
    Open Unimplemented
    Issued to CMS
    04/24/2023
    Audit Report
    A-09-22-03004
  • Administration for Children and Families
    PROCESS
    CHANGE

    The Office of Refugee Resettlement Needs To Improve Its Oversight Related to the Placement and Transfer of Unaccompanied Children
    23-A-06-074.02
    We recommend that the Office of Refugee Resettlement strengthen oversight of transfers between care provider facilities by requiring that all transfer documentation be maintained in the UC Portal and by developing procedures for tracking and reviewing that documentation.
    PROCESS
    CHANGE
    Implementation requires the responsible agency to change a program’s system or procedure.

    Status
    Open Unimplemented
    Issued to ACF
    05/23/2023
    Audit Report
    A-06-20-07002
  • Centers for Medicare and Medicaid Services
    PROGRAM
    CHANGE

    High Rates of Prior Authorization Denials by Some Plans and Limited State Oversight Raise Concerns About Access to Care in Medicaid Managed Care
    23-E-09-029.04
    CMS should require States to implement automatic external medical reviews of upheld MCO prior authorization denials.
    PROGRAM
    CHANGE
    Implementation requires the responsible agency to change a program’s policies, activities, requirements, etc.

    Status
    Open Unimplemented
    Issued to CMS
    07/17/2023
    Evaluation Report
    OEI-09-19-00350
  • Food and Drug Administration
    PROGRAM
    CHANGE

    FDA Could Take Stronger Enforcement Action Against Tobacco Retailers With Histories of Sales to Youth and Other Violations
    23-E-01-040.02
    FDA should determine whether variation in inspection activity on the basis of neighborhoods' socioeconomic status is appropriate and the extent to which it is meeting FDA's objective for protecting vulnerable populations.
    PROGRAM
    CHANGE
    Implementation requires the responsible agency to change a program’s policies, activities, requirements, etc.

    Status
    Open Unimplemented
    Issued to FDA
    09/18/2023
    Evaluation Report
    OEI-01-20-00240
  • Centers for Medicare and Medicaid Services
    PROGRAM
    CHANGE

    Biosimilars Have Lowered Costs for Medicare Part B and Enrollees, but Opportunities for Substantial Spending Reductions Still Exist
    23-E-05-042.01
    CMS should pursue one or more payment changes that could further realize savings from biosimilars for Part B and enrollees.
    PROGRAM
    CHANGE
    Implementation requires the responsible agency to change a program’s policies, activities, requirements, etc.

    Status
    Open Unimplemented
    Issued to CMS
    09/26/2023
    Evaluation Report
    OEI-05-22-00140
  • Centers for Medicare and Medicaid Services
    $694.0M
    Potential Savings

    Medicare Could Save Millions if It Implements an Expanded Hospital Transfer Payment Policy for Discharges to Postacute Care
    24-A-01-002.01
    We recommend that CMS conduct an analysis of its hospital transfer payment policy for discharges to PAC and expand the policy as necessary.
    $694.0M
    Potential Savings

    Status
    Open Unimplemented
    Issued to CMS
    10/06/2023
    Audit Report
    A-01-21-00504
  • Administration for Strategic Preparedness and Response
    PROCESS
    CHANGE

    The Strategic National Stockpile Was Not Positioned To Respond Effectively to the COVID-19 Pandemic
    24-A-04-003.02
    We recommend that ASPR develop a strategic plan for the Stockpile, that clearly defines the goals and objectives of the Stockpile, and the Stockpile's roles and responsibilities for responding to emergency events, including pandemics.
    PROCESS
    CHANGE
    Implementation requires the responsible agency to change a program’s system or procedure.

    Status
    Open Unimplemented
    Issued to ASPR
    10/16/2023
    Audit Report
    A-04-20-02028
  • Centers for Medicare and Medicaid Services
    PROCESS
    CHANGE

    Multiple States Made Medicaid Capitation Payments to Managed Care Organizations After Enrollees' Deaths
    24-A-04-018.03
    We recommend that CMS continue to explore opportunities for using T-MSIS and SSA's DMF data to improve its oversight of the Medicaid program. Specifically, CMS should develop a process to match enrollment and payment information in T-MSIS with the DMF and provide the results of that match to States to help reduce Medicaid capitation payments made to MCOs on behalf of deceased enrollees.
    PROCESS
    CHANGE
    Implementation requires the responsible agency to change a program’s system or procedure.

    Status
    Open Unimplemented
    Issued to CMS
    11/24/2023
    Audit Report
    A-04-21-09005
  • National Institutes of Health
    PROGRAM
    CHANGE

    NIH Did Not Consistently Meet Federal Single Audit Requirements for Extramural Grants
    24-E-04-006.03
    NIH should ensure that relevant single audit data are available and used by NIH staff to inform decisions about new and ongoing awards.
    PROGRAM
    CHANGE
    Implementation requires the responsible agency to change a program’s policies, activities, requirements, etc.

    Status
    Open Unimplemented
    Issued to NIH
    12/14/2023
    Evaluation Report
    OEI-04-21-00160
  • Administration for Children and Families
    PROGRAM
    CHANGE

    Gaps in Sponsor Screening and Followup Raise Safety Concerns for Unaccompanied Children
    24-E-07-009.01
    ACF should implement additional safeguards to ensure that all safety checks are conducted and documented, as required, prior to approving the release of a child to their sponsor.
    PROGRAM
    CHANGE
    Implementation requires the responsible agency to change a program’s policies, activities, requirements, etc.

    Status
    Open Unimplemented
    Issued to ACF
    02/08/2024
    Evaluation Report
    OEI-07-21-00250
  • Centers for Medicare and Medicaid Services
    PROCESS
    CHANGE

    CMS Did Not Ensure That Selected States Complied With Medicaid Managed Care Mental Health and Substance Use Disorder Parity Requirements
    24-A-02-050.01
    We recommend that the Centers for Medicare & Medicaid Services improve its oversight of States' compliance with MH/SUD parity requirements, including strengthening its followup procedures, including regular communication with States, to verify that States perform parity analyses across their MH/SUD delivery systems.
    PROCESS
    CHANGE
    Implementation requires the responsible agency to change a program’s system or procedure.

    Status
    Open Unimplemented
    Issued to CMS
    03/25/2024
    Audit Report
    A-02-22-01016
  • Administration for Children and Families
    PROCESS
    CHANGE

    Administration for Children and Families Data Hosted in Certain Cloud Information Systems May Be at a High Risk of Compromise
    24-A-18-057.04
    We reccomend ACF leverage cloud security assessment tools to identify misconfigurations and weak cybersecurity controls in its cloud infrastructure.
    PROCESS
    CHANGE
    Implementation requires the responsible agency to change a program’s system or procedure.

    Status
    Open Unimplemented
    Issued to ACF
    03/28/2024
    Audit Report
    A-18-22-08020
  • Centers for Medicare and Medicaid Services
    PROGRAM
    CHANGE

    Concerns Remain About Safeguards To Protect Residents During Facility-Initiated Discharges From Nursing Homes
    24-E-01-012.02
    CMS should require nursing homes to systematically document facility-initiated discharges in information available to CMS and States to enhance oversight.
    PROGRAM
    CHANGE
    Implementation requires the responsible agency to change a program’s policies, activities, requirements, etc.

    Status
    Open Unimplemented
    Issued to CMS
    03/29/2024
    Evaluation Report
    OEI-01-18-00251