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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 641–660 of 1,223 reports, containing 4,008 recommendations
Sorted by latest release date
-
Communication and Management Challenges Impeded HHS's Response to the Zero-Tolerance Policy
20-E-BL-011.01HHS should take steps to ensure that children's interests are prioritized and represented in decisions affecting the UAC Program, both internally and when engaging with interagency partners.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/30/2023
- Legislative Related
- No
20-E-BL-011.02HHS should modify or pursue formal agreements with DHS and DOJ to ensure that it is receiving information that supports its operation of and ability to provide care for children in the UAC Program.- Status
- Open Unimplemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 05/20/2024
- Next Update Expected
- 09/16/2025
- Legislative Related
- No
20-E-BL-011.03HHS should improve communication to care provider facilities regarding interim guidance, operational directives, and other instructions that are not immediately available in published policy documents.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/25/2020
- Legislative Related
- No
20-E-BL-011.04HHS should further improve its ability to identify and track separated children by reducing reliance on manual processes.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/30/2023
- Legislative Related
- No
-
Medicare Hospital Provider Compliance Audit: Saint Francis Health Center
20-A-07-069.01We recommend that Saint Francis Health Center refund to the Medicare contractor $5,533,169 of the estimated overpayments for the claims incorrectly billed that are within the Medicare reopening period.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $5,533,169
- Last Update Received
- 10/07/2024
- Next Update Expected
- 03/24/2025
- Legislative Related
- No
20-A-07-069.02We recommend that Saint Francis Health Center for the remaining portion of the estimated $5,533,169 overpayment for claims that are outside of the Medicare reopening period, exercise reasonable diligence to identify and return overpayments, in accordance with the 60-day rule, and identify any 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
- 09/24/2024
- Legislative Related
- No
20-A-07-069.03We recommend that Saint Francis Health Center exercise reasonable diligence to identify and return any additional similar overpayments outside of our audit period, in accordance with the 60-day rule, and identify any 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
- 09/24/2024
- Legislative Related
- No
20-A-07-069.04We recommend that Saint Francis Health Center strengthen controls to ensure full compliance with Medicare requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/29/2023
- Legislative Related
- No
-
The Centers for Medicare & Medicaid Services Did Not Identify and Report Potential Antideficiency Act Violations for 12 Contracts Used To Establish the Federal Marketplace Under the Affordable Care Act
20-A-03-068.01We recommend that the Centers for Medicare & Medicaid Services correct the bona fide needs obligation violations totaling $164,606,982 ($155,866,794 related to the Federal marketplace) and, if CMS is unable to correct those violations, report the Antideficiency Act violations.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $164,606,982
- Last Update Received
- -
- Closed Date
- 10/01/2023
- Legislative Related
- No
20-A-03-068.02We recommend that the Centers for Medicare & Medicaid Services correct the bona fide needs expenditure violations totaling $22,386,227 ($18,269,216 related to the Federal marketplace) and, if CMS is unable to correct those violations, report the Antideficiency Act violations.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Partial Concur
- Potential Savings
- $22,386,227
- Last Update Received
- -
- Closed Date
- 10/01/2023
- Legislative Related
- No
20-A-03-068.03We recommend that the Centers for Medicare & Medicaid Services coordinate with HHS, in consultation with the Office of the General Counsel, to develop guidance and train OFM personnel on the correct process to record obligations and expenditures to avoid potential Antideficiency Act violations.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/12/2022
- Legislative Related
- No
20-A-03-068.04We recommend that the Centers for Medicare & Medicaid Services develop automated controls in HIGLAS to ensure that contract expenditures for each program year are paid using appropriate program-year obligations.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/16/2023
- Legislative Related
- No
-
National Institutes of Health Had Information Technology Control Weaknesses Surrounding Its Electronic Health Record System
20-A-18-067.01Complete the NIST requirements for implementing an alternative processing site that is a reasonable and viable option. Identify, document, and implement actions to mitigate risks of using existing alternative site based on the risk assessment results until compliant alternate site is established.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/19/2020
- Legislative Related
- No
20-A-18-067.02Implement policies and procedures to ensure all software is upgraded or replaced prior to end of life.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/02/2020
- Legislative Related
- No
20-A-18-067.03Ensure that the automated CRIS User Account Management tool is operating as intended and confirm that all changes to user privileges are authorized, properly documented, and inactive accounts are deactivated.- Status
- Closed Implemented
- Responsible Agency
- NIH
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/02/2020
- Legislative Related
- No
-
CHI St. Vincent Infirmary: Audit of Outpatient Outlier Payments
20-A-06-066.01We recommend that CHI St. Vincent Infirmary return the $362,999 in improper outlier payments for the 70 claims that have been amended correctly.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $362,999
- Last Update Received
- -
- Closed Date
- 09/07/2023
- Legislative Related
- No
20-A-06-066.02We recommend that CHI St. Vincent Infirmary improve procedures and provide education to ensure claims billed to Medicare are accurate.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/25/2020
- Legislative Related
- No
20-A-06-066.03We recommend that CHI St. Vincent Infirmary amend the 33 claims (10 incorrectly amended and 23 not amended) to identify and return any improper outlier payments that are within the 4-year claims reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/07/2023
- Legislative Related
- No
20-A-06-066.04We recommend that CHI St. Vincent Infirmary for any of the 33 claims that are outside of the 4-year claims reopening period, exercise reasonable diligence to identify and return overpayments in accordance with the 60-day rule, and identify any 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
- 08/24/2022
- Legislative Related
- No
20-A-06-066.05We recommend that CHI St. Vincent Infirmary exercise reasonable diligence to identify and return any additional similar overpayments (including overpayments received during our audit period for the remaining $1,072,249 in outlier payments that we did not review and overpayments outside of our audit period), in accordance with the 60-day rule, and identify any 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
- 09/07/2023
- Legislative Related
- No
-
Ownership—But Not Physical Movement—of Selected Drugs Can Be Traced Through the Supply Chain
20-E-05-009.01FDA should follow up with the wholesale distributor that did not provide tracing information to OIG.- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/28/2020
- Legislative Related
- No
20-E-05-009.02FDA should provide educational outreach to trading partners about required drug product tracing information and data standardization guidelines.- Status
- Closed Implemented
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/05/2022
- Legislative Related
- No
20-E-05-009.03FDA should seek legislative authority to include information about a drug product's complete physical path through the supply chain on drug product tracing information.- Status
- Closed Acceptable Alternative
- Responsible Agency
- FDA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/10/2023
- Legislative Related
- Yes
-
New York Made Unallowable Payments Totaling More Than $10 Million for Managed Care Beneficiaries Assigned Multiple Medicaid Identification Numbers
20-A-02-065.01We recommend that the New York State Department of Health refund $11,257,368 to the Federal Government.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $11,257,368
- Last Update Received
- 10/04/2024
- Next Update Expected
- 09/14/2024
- Legislative Related
- No
20-A-02-065.02We recommend that the New York State Department of Health identify and recover improper managed care payments made to different MCOs on behalf of beneficiaries with multiple Medicaid ID numbers prior to and after our audit period, and repay the Federal share of the amounts recovered.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/17/2023
- Legislative Related
- No
20-A-02-065.03We recommend that the New York State Department of Health strengthen its procedures for determining whether an individual applying for Medicaid has already been assigned a Medicaid ID number by ensuring that its system queries identify all individuals with existing Medicaid ID numbers and - local district and Marketplace staff follow guidance on identifying individuals with Medicaid ID numbers and use all available resources to identify and prevent the issuance of multiple Medicaid ID numbers to the same individual.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/31/2023
- Legislative Related
- No
-
New York Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs
20-A-02-063.01We recommend that the New York Department of Health refund to the Federal Government $3,197,404 (Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $3,197,404
- Last Update Received
- -
- Closed Date
- 10/16/2024
- Legislative Related
- No
20-A-02-063.02We recommend that the New York Department of Health refund to the Federal Government $146,672 (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
- Concur
- Potential Savings
- $146,672
- Last Update Received
- -
- Closed Date
- 10/16/2024
- Legislative Related
- No
20-A-02-063.03We recommended that the New York Department of Health work with CMS to determine the unallowable portion of $2,340,390 (Federal share) for other claims for covered outpatient physician-administered drugs that were submitted without NDCs and that may have been ineligible for Federal reimbursement and refund that amount, and whether the remaining $714,777 (Federal share) of other physician-administered drug claims could have been invoiced to the manufacturers to receive rebates and, if so, upon receipt of the rebates, refund the Federal share of the manufacturers' rebates for those claims.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 03/11/2024
- Next Update Expected
- 09/12/2024
- Legislative Related
- No
20-A-02-063.04We recommended that the New York Department of Health work with CMS to determine and refund the unallowable portion of Federal reimbursement for physician-administered drugs that were not invoiced for rebates after December 31, 2017.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 11/03/2023
- Next Update Expected
- 05/03/2024
- Legislative Related
- No
20-A-02-063.05We recommended that the New York Department of Health strengthen its internal controls to ensure that all physician-administered drugs eligible for rebates are invoiced.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/30/2023
- Legislative Related
- No
-
New Mexico's Monitoring of Childcare Providers Generally Ensured Provider Compliance With State Criminal Background Check Requirements at 30 Childcare Providers Reviewed
20-A-06-064.01We recommend that New Mexico's Children, Youth, and Families Department ensure all required background checks are conducted for the 1 individual that did not have the required checks within the past 5 years at the time of our review.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/18/2022
- Legislative Related
- No
20-A-06-064.02We recommend that New Mexico's Children, Youth, and Families Department determine if the fingerprint system has the ability to notify BCU when fingerprints for childcare providers are submitted to DPS and if so implement this process.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/18/2022
- Legislative Related
- No
20-A-06-064.03We recommend that New Mexico's Children, Youth, and Families Department develop a process for BCU to notify The State Licensing Agency and the childcare provider when a background check is not completed due to lack of documentation or childcare staff member non-response.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/18/2022
- Legislative Related
- No
20-A-06-064.04We recommend that New Mexico's Children, Youth, and Families Department determine if the EPICS system can track and notify the child care provider one month before a childcare staff member's background check clearance expires and if so implement this process.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/18/2022
- Legislative Related
- No
20-A-06-064.05We recommend that New Mexico's Children, Youth, and Families Department implement name-based checks of the NCIC NSOR and complete checks on all childcare staff members.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 07/18/2022
- Legislative Related
- No
-
Michigan Made Capitation Payments to Managed Care Entities After Beneficiaries' Deaths
20-A-05-062.01We recommend that the Michigan Department of Health and Human Services refund $27,545,800 to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $27,545,800
- Last Update Received
- -
- Closed Date
- 03/19/2024
- Legislative Related
- No
20-A-05-062.02We recommend that the Michigan Department of Health and Human Services identify and recover unallowable payments made to managed care entities during our audit period on behalf of deceased beneficiaries, which we estimate to be at least $39,873,514.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/18/2023
- Legislative Related
- No
20-A-05-062.03We recommend that the Michigan Department of Health and Human Services identify capitation payments made on behalf of deceased beneficiaries before and after our audit period and repay the Federal share of amounts recovered.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/19/2024
- Legislative Related
- No
20-A-05-062.04We recommend that the Michigan Department of Health and Human Services strengthen its policies and procedures for identifying deceased beneficiaries to ensure that dates of death are recorded accurately and in a timely manner in the CHAMPS to prevent unallowable payments.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/03/2023
- Legislative Related
- No
20-A-05-062.05We recommend that the Michigan Department of Health and Human Services ensure that capitation payments are recovered when a date of death is retroactively entered in the CHAMPS.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/03/2023
- Legislative Related
- No
-
Wateree Community Actions, Inc., Made Improvements but Still Requires Monitoring
20-A-04-060.01We recommend that Wateree Community Actions, Inc. monitor the non-Federal match it is receiving throughout the budget year and, if needed, either request a waiver from ACF immediately upon determining that it cannot meet its match requirements or adjust its Federal funds grant expenditures accordingly.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/28/2020
- Legislative Related
- No
20-A-04-060.02We recommend that Wateree Community Actions, Inc. ensure adequate controls are in place to prevent invoicing both Head Start and the USDA Child Nutrition programs for the same expenses.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/28/2020
- Legislative Related
- No
20-A-04-060.03We recommend that Wateree Community Actions, Inc. establish a tracking system to ensure that all required Federal reports are completed and submitted on time.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/28/2020
- Legislative Related
- No
20-A-04-060.04We recommend that Wateree Community Actions, Inc. train staff on how to accurately complete the SF-425.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/28/2020
- Legislative Related
- No
-
The Majority of Providers Reviewed Used Medicare Part D Eligibility Verification Transactions for Potentially Inappropriate Purposes
20-A-05-059.01We recommend that the Centers for Medicare & Medicaid Services continue to monitor providers submitting a high number of E1 transactions relative to prescriptions processed.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/04/2021
- Legislative Related
- No
20-A-05-059.02We recommend that the Centers for Medicare & Medicaid Services issue guidance that clearly states that E1 transactions should not be used for marketing purposes.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/04/2021
- Legislative Related
- No
20-A-05-059.03We recommend that the Centers for Medicare & Medicaid Services ensure that only pharmacies and other authorized entities submit E1 transactions.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/04/2021
- Legislative Related
- No
20-A-05-059.04We recommend that the Centers for Medicare & Medicaid Services take appropriate enforcement action when abuse is identified.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/04/2021
- Legislative Related
- No
-
Opportunities for Williamson and Burnet Counties Had Ineffective Accounting Controls and Used Unapproved or Questionable Cost Allocation Methods
20-A-06-058.01We recommend that Opportunities for Williamson and Burnet Counties implement procedures designed to ensure that Federal funds are drawn down only in the amounts needed to meet the immediate cash requirements of its CSBG and LIHEAP-related activities.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/07/2020
- Legislative Related
- No
20-A-06-058.02We recommend that Opportunities for Williamson and Burnet Counties instruct and train its finance employees to use the grant year program code built into the accounting software to identify revenues and expenses by specific grant year for all Head Start, CSBG, and LIHEAP general ledger transactions.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/07/2020
- Legislative Related
- No
20-A-06-058.03We recommend that Opportunities for Williamson and Burnet Counties train employees to follow existing policies and procedures for approval of expenses.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/07/2020
- Legislative Related
- No
20-A-06-058.04We recommend that Opportunities for Williamson and Burnet Counties work with CAS to either be released from the existing indirect cost rate or negotiate a current indirect cost rate for claiming future indirect costs.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/07/2020
- Legislative Related
- No
20-A-06-058.05We recommend that Opportunities for Williamson and Burnet Counties develop and implement a reasonable basis to allocate meal costs, kitchen salaries, and central office expenses between the Head Start and Senior Nutrition programs in accordance with the benefits received.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/07/2020
- Legislative Related
- No
20-A-06-058.06We recommend that Opportunities for Williamson and Burnet Counties refund $3,207 in unallowable costs.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- $3,207
- Last Update Received
- -
- Closed Date
- 02/07/2020
- Legislative Related
- No
-
The Federal Marketplace Properly Determined Individuals' Eligibility for Enrollment in Qualified Health Plans but Improperly Determined That an Estimated 3 Percent of Individuals Were Eligible for Insurance Affordability Programs
20-A-09-057.01Although the Federal marketplace properly determined most individuals' eligibility for insurance affordability programs, to address the specific deficiencies that we identified, we recommend that the Centers for Medicare & Medicaid Services redetermine, if necessary, the eligibility of the eight sampled individuals for whom eligibility for insurance affordability programs was not or may not have been determined in accordance with Federal requirements.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/02/2021
- Legislative Related
- No
20-A-09-057.02Although the Federal marketplace properly determined most individuals' eligibility for insurance affordability programs, to address the specific deficiencies that we identified, we recommend that the Centers for Medicare & Medicaid Services take steps to ensure that the Federal marketplace revises its written guidance so that it does not extend an individual's inconsistency period when the marketplace receives returned mail.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/02/2021
- Legislative Related
- No
20-A-09-057.03Although the Federal marketplace properly determined most individuals' eligibility for insurance affordability programs, to address the specific deficiencies that we identified, we recommend that the Centers for Medicare & Medicaid Services take steps to ensure that the Federal marketplace corrects an error in its eligibility and enrollment system so that the system does not incorrectly show that an individual is no longer enrolled in a QHP.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/02/2021
- Legislative Related
- No
20-A-09-057.04Although the Federal marketplace properly determined most individuals' eligibility for insurance affordability programs, to address the specific deficiencies that we identified, we recommend that the Centers for Medicare & Medicaid Services take steps to ensure that the Federal marketplace corrects an error in its eligibility and enrollment system so that information on whether an individual met the 5 year bar does not automatically carry over from a previous coverage year.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/02/2021
- Legislative Related
- No
20-A-09-057.05Although the Federal marketplace properly determined most individuals' eligibility for insurance affordability programs, to address the specific deficiencies that we identified, we recommend that the Centers for Medicare & Medicaid Services take steps to ensure that the Federal marketplace implements a change in its eligibility and enrollment system so that the system maintains data showing that verifications of minimum essential coverage through non-ESI were performed, even if responses were not received from some of the electronic data sources.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/02/2021
- Legislative Related
- No
20-A-09-057.06Although the Federal marketplace properly determined most individuals' eligibility for insurance affordability programs, to address the specific deficiencies that we identified, we recommend that the Centers for Medicare & Medicaid Services take steps to ensure that the Federal marketplace corrects an error in its eligibility and enrollment system so that the marketplace generates an inconsistency when an individual's attested information related to eligibility for minimum essential coverage through ESI is not completed.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/02/2021
- Legislative Related
- No
20-A-09-057.07Although the Federal marketplace properly determined most individuals' eligibility for insurance affordability programs, to address the specific deficiencies that we identified, we recommend that the Centers for Medicare & Medicaid Services take steps to ensure that the Federal marketplace establishes guidance to exclude income from other gains on a Federal tax return submitted by an individual when resolving an income inconsistency.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/02/2021
- Legislative Related
- No
20-A-09-057.08To improve procedures related to verifying whether individuals complied with the requirement to file a Federal tax return and reconcile APTC payments, we recommend that the Centers for Medicare & Medicaid Services require an individual to submit supporting documentation (e.g., a Federal tax return with IRS Form 8962) when he or she attests to having filed a tax return to reconcile a previous year's APTC payments.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/02/2021
- Legislative Related
- No
20-A-09-057.09To improve procedures related to verifying whether individuals complied with the requirement to file a Federal tax return and reconcile APTC payments, we recommend that the Centers for Medicare & Medicaid Services ensure that the Federal marketplace's eligibility and enrollment system performs subsequent FTR verifications for an individual who received an FTR indicator for a tax-filing extension.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/02/2021
- Legislative Related
- No
-
Life Safety and Emergency Preparedness Deficiencies Found at 18 of 20 Texas Nursing Homes
20-A-06-056.01We recommend that Texas follow up with the 18 nursing homes to verify that corrective actions have been taken regarding the life safety and emergency preparedness deficiencies identified in this report.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/16/2020
- Legislative Related
- No
-
New York Claimed Tens of Millions of Dollars for Opioid Treatment Program Services That Did Not Comply With Medicaid Requirements Intended To Ensure the Quality of Care Provided to Beneficiaries
20-A-02-054.01We recommend that the New York State Department of Health refund $39,329,059 to the Federal Government.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $39,329,059
- Last Update Received
- 07/31/2020
- Next Update Expected
- 06/30/2022
- Legislative Related
- No
20-A-02-054.02We recommend that the New York State Department of Health ensure that providers comply with Federal and State requirements for providing and claiming reimbursement for OTP services.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 07/31/2020
- Next Update Expected
- 06/30/2022
- Legislative Related
- No
20-A-02-054.03We recommend that the New York State Department of Health implement procedures to detect and prevent duplicate claims for OTP services.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 07/31/2020
- Next Update Expected
- 06/30/2022
- Legislative Related
- No
-
Geographic Disparities Affect Access to Buprenorphine Services for Opioid Use Disorder
20-E-12-006.01SAMHSA should geographically target its efforts to increase the participation of waivered providers in high-need counties.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/15/2021
- Legislative Related
- No
-
Missouri Medicaid Fraud Control Unit: 2018 Onsite Inspection
20-E-12-007.01Take steps to ensure that Unit case files include all relevant facts, information, and significant documents- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/06/2020
- Legislative Related
- No
20-E-12-007.02Revise the Unit's policies and procedures manual to include a specific frequency for conducting periodic supervisory reviews of Unit case files, and take steps to ensure that case files include documentation of periodic supervisory reviews- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/06/2020
- Legislative Related
- No
20-E-12-007.03Take steps to ensure that the Unit consistently reports all convictions and adverse actions to Federal partners- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/06/2020
- Legislative Related
- No
20-E-12-007.04Establish training-hour requirements for Unit investigators and ensure that all investigators receive annual training- Status
- Closed Implemented
- Responsible Agency
- MFCU
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/06/2020
- Legislative Related
- No
-
The Indiana State Medicaid Agency Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths
20-A-05-053.01We recommend that the Indiana Family and Social Services Administration refund $862,097 to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $862,097
- Last Update Received
- -
- Closed Date
- 09/09/2021
- Legislative Related
- No
20-A-05-053.02We recommend that the Indiana Family and Social Services Administration identify and recover unallowable payments made to MCOs during our audit period on behalf of deceased beneficiaries, which we estimate to be at least $1,163,487.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $1,162,159
- Last Update Received
- -
- Closed Date
- 09/09/2021
- Legislative Related
- No
20-A-05-053.03We recommend that the Indiana Family and Social Services Administration identify capitation payments made on behalf of deceased beneficiaries before and after our audit period, and repay the Federal share of amounts recovered.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/25/2020
- Legislative Related
- No
20-A-05-053.04We recommend that the Indiana Family and Social Services Administration ensure that dates of death are added to the MMIS and that capitation payments made after the beneficiaries' deaths are recovered.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/25/2020
- Legislative Related
- No
-
More Than One-Third of New Jersey's Federal Medicaid Reimbursement for Providing Community-Based Treatment Services Was Unallowable
20-A-02-052.01We recommend that the New Jersey Department of Human Services refund $14,888,980 to the Federal Government.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $14,888,980
- Last Update Received
- 09/27/2024
- Next Update Expected
- 04/04/2025
- Legislative Related
- No
20-A-02-052.02We recommend that the New Jersey Department of Human Services reinforce guidance to the provider community regarding Federal and State requirements for claiming Medicaid reimbursement for PACT services.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/28/2024
- Legislative Related
- No
20-A-02-052.03We recommend that the New Jersey Department of Human Services improve its procedures for monitoring PACT services providers, including implementing procedures to identify deficiencies similar to those identified in this report.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/28/2024
- Legislative Related
- No
20-A-02-052.04We recommend that the New Jersey Department of Human Services consider developing regulations for periodic reassessments to determine whether beneficiaries enrolled in PACT continue to require PACT services.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Next Update Expected
- Legislative Related
- No