Recommendations Tracker

CMS should geographically target efforts to increase the number of MOUD providers that treat Medicare enrollees in high-need counties.

CMS should work with SAMHSA to develop and maintain a list of active office-based buprenorphine providers.

CMS should pursue further actions to help States share knowledge with eachother and coordinate internally regarding strategies to ensure needed care for Medicaid enrollees with HIV.

We recommend that Novitas develop and deliver education to auditors and supervisors regarding applicable criteria and review requirements.

ACF should monitor whether States are conducting credit checks of all three CRAs for children aged 14 or older who are in foster care, as required.

ACF should seek to partner with other government agencies to develop strategies to address issues that States experienced working with CRAs.

We recommend the Massachusetts Executive Office of Health & Human Services follow up with the OTP providers to correct the three services that were not supported by the medical records.

We recommend that the South Carolina Department of Health and Human Services invoice for and collect manufacturers' rebates totaling $12,204,259 (Federal share) for single-source and top-20 multiple-source physician-administered drugs and refund the Federal share of rebates collected.

We recommend that the South Carolina Department of Health and Human Services ensure that all physician-administered drugs eligible for rebates after our audit period are processed for rebates.

We recommend that the Utah Department of Health and Human Services redetermine Medicaid eligibility for the six sampled enrollees whom we have identified as having had incorrectly completed eligibility determinations.

We recommend that the Utah Department of Health and Human Services identify and correct the eREP data limitations, which in some cases prevented proper reporting classification.

We recommend that the New Mexico Human Services Department work with the MCOs todevelop procedures to monitor PCS provider compliance with attendant qualifications, including those related to criminal background checks, abuse registry checks, TB tests, initial written competency tests, annual training, and CPR and first aid certifications; educate providers more frequently through methods such as guidance letters or webinars to increase PCS providers' understanding of attendant qualification requirements; and take corrective action against providers that do not ensure that attendants comply with qualification requirements, which could include removing providers that repeatedly fail to comply with the State's PCS program.

We recommend that the Kansas Department of Health and Education improve its electronic visit verification system by developing and implementing procedures to verify that in-home PCS claims are recorded and verified in its EVV system, and implementing edits to verify that tasks recorded on in-home PCS claims match allowable tasks approved in the PCSP.    

We recommend that the Kansas Department of Health and Education verify that providers are complying with the State agency's established policies and procedures to maintain documentation showing that service workers are registered, screened, and employable pursuant to background check requirements.

We recommend that the Centers for Medicare & Medicaid Services instruct the SSAs to follow up with the 24 nursing homes that may not have complied with Federal requirements to verify that they have taken corrective actions.

We recommend that the Illinois Department of Healthcare and Family Services remediate the four security control findings identified by OIG.

We recommend that the Illinois Department of Healthcare and Family Services enhance its testing procedures to include performing more robust technical testing of web-facing systems and emulation of an adversary's tactics and techniques on a defined reoccurring basis, in order to better assess the effectiveness of NIST SP 800-53 controls.

We recommend that MMM Healthcare, LLC, refund to the Federal Government the $165,312 of net overpayments.

We recommend that the Massachusetts' Executive Office of Health and Human Services redetermine eligibility for the three sampled enrollees whose eligibility was incorrectly determined and take appropriate action.

We recommend that the Massachusetts' Executive Office of Health and Human Services revise policies and procedures to be consistent with CMS guidance related to preparing unwinding data reports and any future reports of a similar nature.

We recommend that the Centers for Medicare & Medicaid Services direct the MACs to recover from hospitals the portion of the $382,032 in identified overpayments for the sampled claims during our audit period that are within the 4-year reopening period in accordance with CMS's policies and procedures.

We recommend that the Washington State Health Care Authority work with its contracted MCOs and the Department of Health to ensure that OTPs comply with Federal and State requirements for providing and documenting OTP services, including ensuring that OTPs complete required tests for enrollee admissions and adequately document enrollee admissions.

We recommend that the Washington State Health Care Authority work with its contracted MCOs and the Department of Health to ensure that OTPs comply with Federal and State requirements for providing and documenting OTP services, including ensuring that OTPs provide take-home medications in accordance with Federal and State requirements.

We recommend that the Washington State Health Care Authority work with its contracted MCOs and the Department of Health to ensure that OTPs comply with Federal and State requirements for providing and documenting OTP services, including ensuring that OTPs adequately document the results of drug screens.

We recommend that the Washington State Health Care Authority work with its contracted MCOs and the Department of Health to ensure that OTPs comply with Federal and State requirements for providing and documenting OTP services, including ensuring that OTPs adequately document enrollee assessments.

We recommend that the Washington State Health Care Authority work with its contracted MCOs and the Department of Health to ensure that OTPs comply with Federal and State requirements for providing and documenting OTP services, including ensuring that OTPs complete and adequately document annual medical examinations.

Revise its procedures for screening referrals to incorporate the expertise of each professional discipline and to reflect current Unit priorities and workloads

Revise its procedures for opening, assigning, and closing cases to better enable cases to be completed in an appropriate timeframe

Take steps to improve the accuracy and completeness of case information and performance data in its electronic case management system

Take steps to improve its ability to staff its administrative functions consistently and appropriately

Establish procedures for regularly communicating and coordinating with OIG's Office of Investigations and the U.S. Attorney's Office

Revise its policies and procedures for periodic supervisory reviews and conduct and document the reviews in accordance with its updated policies

Include acknowledgments of Federal funding in its press releases and other public documents

We recommend that Heluna Health refund $3,585,834 to the Federal government.

We recommend that Heluna Health work with CDC to determine the allowable portion of $366,850,858 related to local health jurisdiction (LHJ) start-up costs and refund to the Federal Government any unallowable amount.

We recommend that the California Department of Health Care Services resume and enhance procedures that are in accordance with current Federal requirements to identify and disenroll enrollees who are residing and enrolled in Medicaid managed care in another State.

Eliminate access to sensitive case material for unauthorized staff

Take steps to report adverse actions to the NPDB within the required timeframe

Implement a method to monitor the State's responses to the Unit's program recommendations

We recommend that the HHS Office of the Secretary develop a procedure to ensure cloud system inventories are accurate and completed in accordance with HHS security requirements.

We recommend that the HHS Office of the Secretary implement a strategy that includes leveraging cloud security assessment tools that identify misconfigurations and other control weaknesses in its cloud services, and remediate weak controls in a timely manner.