Recommendations Tracker

We recommend that the Louisiana Department of Health promptly provide notice and cancel the eligibility of beneficiaries identified with income over the allowable limit.

We recommend that Louisiana's Department of Health redetermine, if necessary, the current Medicaid eligibility status of the sample beneficiaries for whom income or dependent verifications did not meet Federal and State requirements.

We recommend that the Massachusetts Executive Office of Health and Human Services refund to the Federal Government $7,071,365 in estimated overpayments for NEMT claim lines associated with NEMT services that did not comply with Federal and State requirements.

We recommend that the Massachusetts Executive Office of Health and Human Services work with its brokers to implement controls that ensure NEMT services are sufficiently supported by requiring brokers to verify that documentation contains all the necessary elements (in a legible manner) to support the NEMT service; evaluating whether GPS or other monitoring of drivers would be an effective control to verify whether transportation had occurred or was to the destination listed on the PT-1; and implementing controls that verify that the beneficiary was in the vehicle on the day of the billed NEMT service.

We recommend that the Massachusetts Executive Office of Health and Human Services give brokers the authority to deny unusual transportation requests when medical services cannot be verified (e.g., medical appointment after business hours).

We recommend that the California Department of Health Care Services refund $2,416,900 to the Federal Government for unallowable OTP services furnished by the selected provider.

We recommend that the California Department of Health Care Services verify that the selected provider implements corrective action plans that were approved by the State agency.

We recommend that the California Department of Health Care Services work with the selected provider to improve the quality of care provided to beneficiaries by correcting deficiencies.

We recommend that the Choctaw Nation of Oklahoma refund unallowable costs of $2,405 to the TOR grant.

We recommend that the Choctaw Nation of Oklahoma strengthen policies and procedures by clarifying responsibilities between and within Tribal departments for the review and approval of costs submitted on contractor invoices.

We recommend that the Centers for Medicare & Medicaid Services review the list of 100 error-prone providers identified in this audit and take specific action as appropriate, such as prior authorization, prepayment reviews, and postpayment review.

We recommend that Southeastern Home Health Services, based on the results of this audit, 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.

CMS should work with States to expand alternative reimbursement models to address the rising costs for drugs often categorized as specialty drugs.

CMS should collaborate with States to conduct greater oversight of Medicaid MCOs' management of specialty drugs; this oversight could include a review of contract language that allows States to obtain requested information on specialty drug categorizations, specialty drug reimbursement methodologies, and cost management strategies.

We recommend that Tender Touch Health Care Services refund to the Medicare program the portion of the estimated $478,780 overpayment for claims incorrectly billed that are within the 4-year reopening period.

We recommend that Tender Touch Health Care Services strengthen its procedures to ensure that the homebound statuses of Medicare beneficiaries are verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented and beneficiaries are receiving only reasonable and necessary skilled services.

We recommend that the Centers for Medicare & Medicaid Services work with Texas to determine whether the source of IGTs and the practice of using debt instruments to fund the non-Federal share of QIPP payments meets program objectives and promotes economy and efficiency in Medicaid.

We recommend that the Office of Refugee Resettlement develop plans for upcoming service needs by using all available data and indicators to ensure that it adheres to the FAR competition requirements.

We recommend that the Office of Refugee Resettlement establish a policy and procedure for nominating in writing to PSC the employees it intends to serve as CORs.

We recommend that the Office of Refugee Resettlement establish written policies and procedures for reviewing invoices.

CMS should assess the results of infection control surveys and revise the survey as appropriate.

CMS should clarify expectations for States to complete backlogs of standard surveys and high-priority complaint surveys.

IHS should provide additional guidance and training to facilities on patient protection policies, including the role of law enforcement and the reporting process related to patient abuse.

IHS should examine and revise, as needed, the reporting structure in the policies and the incident reporting system to ensure that staff and patients can report abuse anonymously.

We recommend that Hospice Compassus, Inc., of Tullahoma, Tennessee exercise reasonable diligence to identify, report, and return the estimated $3,464,856 for hospice services that did not comply with Medicare requirements in accordance with the 60-day rule, and identify any of those returned overpayments as having been made in accordance with this recommendation.

We recommend that Hospice Compassus, Inc., of Tullahoma, Tennessee strengthen its procedures to ensure that hospice services comply with Medicare requirements.

We recommend that Providence Medical Center refund to the Medicare contractor the portion of the $325,241 in estimated overpayments for the audit period for claims that it incorrectly billed that are within the 4-year reopening period.

We recommend that Providence Medical Center strengthen controls to ensure full compliance with Medicare requirements.

We recommend that the Centers for Disease Control and Prevention implement requirements for CDC in-country offices to have SOPs for CoAg management.

IHS should assess the costs and benefits of updating its EHR system with tools to support more automated monitoring.

IHS should establish patient harm monitoring and reduction as a key priority of the Office of Quality.

IHS should implement quality improvement plans to improve patient safety across IHS, including plans that focus specifically on smaller hospitals and patient groups at higher risk of harm.

IHS should assess its labor and delivery practices and consider practice improvements based on the findings of this assessment.

IHS should encourage and support greater adoption of AIM's bundles of maternal-safety best practices.

We recommend that the New York State Department of Health refund $54,456,563 to the Federal Government.

We recommend that the New York State of Health reinforce with the local districts and personal care services providers Medicaid requirements related to personal care services to ensure local districts conduct all required assessments and examinations in a timely manner and that they maintain documentation related to the authorization and reauthorization of services; local districts are aware of requirements related to conducting independent medical review; personal care service providers conduct criminal history checks on all aides and verify that all aides meet training requirements prior to providing Medicaid services; and personal care services providers document time spent providing services.

We recommend that Total Patient Care Home Health, LLC strengthen its procedures to ensure that (1) the homebound statuses of Medicare beneficiaries are verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented and (2) beneficiaries are receiving only reasonable and necessary skilled services.