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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 801–820 of 1,223 reports, containing 4,008 recommendations
Sorted by latest release date
-
Although the Administration for Community Living Resolved Nearly All Audit Recommendations, It Did Not Always Do So in Accordance With Federal Timeframe Requirements
19-A-07-073.01We recommend that ACL follow its policies and procedures related to the audit resolution process to ensure that all management decisions are issued within the required 6-month resolution period.- Status
- Closed Implemented
- Responsible Agency
- ACL
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/17/2020
- Legislative Related
- No
19-A-07-073.02We recommend that ACL promptly resolve the six outstanding audit recommendations that were past due as of September 30, 2016.- Status
- Closed Implemented
- Responsible Agency
- ACL
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/17/2020
- Legislative Related
- No
-
The Passamaquoddy Tribe's Pleasant Point Health Center Needs To Improve Its Medical-Referral Process
19-A-01-072.01We recommend that the Passamaquoddy Tribe at Pleasant Point reestablish the practice of conducting MCC meetings that are comprised of the required medical and administrative staff to review referrals on a weekly basis in accordance with Federal requirements.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/14/2019
- Legislative Related
- No
19-A-01-072.02We recommend that the Passamaquoddy Tribe at Pleasant Point develop and implement policies and procedures to ensure accurate documentation of medical referrals, including eliminate the system default settings for referral medical priority level codes; ensure provider training and proper use of the correct medical priority level code definitions; ensure supervision of PRC administrative staff so that referrals are properly closed, accurately documented, and closed individually; and identify process requirements for closing referrals and documenting the reasons that referrals were not completed.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/14/2019
- Legislative Related
- No
19-A-01-072.03We recommend that the Passamaquoddy Tribe at Pleasant Point institute safeguards to prevent the loss of medical referrals from RCIS, including the implementation of a tracking, reporting, and review process that ensures that the RCIS accounts for all medical referrals created.- Status
- Closed Implemented
- Responsible Agency
- IHS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/14/2019
- Legislative Related
- No
-
New Jersey Did Not Provide Adequate Oversight of Its Medicaid Delivery System Reform Incentive Payment Program
19-A-02-070.01We recommend that the State agency work with DOH, the DSRIP program contractor, and the five selected hospitals to determine whether the $50,920,788 ($25,460,394 Federal share) in pay-for performance incentive payments to the five hospitals was appropriate.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/03/2021
- Legislative Related
- No
19-A-02-070.02We recommend that the State agency work with DOH, the DSRIP program contractor, and the 44 hospitals not covered by this review to determine whether the $131,511,277 ($65,755,639 Federal share) in pay-for-performance incentive payments to those hospitals was appropriate.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/03/2021
- Legislative Related
- No
19-A-02-070.03We recommend that the State agency improve its oversight of the DSRIP program to ensure that its contractor maintains the Medicaid claims data necessary to support its determinations for whether hospitals qualify for pay-for-performance incentive payments and hospitals report information consistent with the performance measure criteria to the DSRIP program contractor.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/03/2021
- Legislative Related
- No
-
New York Did Not Provide Adequate Stewardship of Substance Abuse Prevention and Treatment Block Grant Funds
19-A-02-069.01We recommend that SAMHSA provide formal guidance to the State agency on accounting for SABG expenditures.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/22/2021
- Legislative Related
- No
19-A-02-069.02We recommend that SAMHSA provide formal guidance to the State agency on alerting SAMHSA about any unexpended funds.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/22/2021
- Legislative Related
- No
19-A-02-069.03We recommend that SAMHSA provide formal guidance to the State agency on amending the FFR to reflect actual SABG expenditures.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/22/2021
- Legislative Related
- No
19-A-02-069.04We recommend that SAMHSA recover $1,800,212 from the State agency.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- $1,800,212
- Last Update Received
- -
- Closed Date
- 05/26/2022
- Legislative Related
- No
19-A-02-069.05We recommend that the State agency review the revenues reported on the fiscal reports of providers not reviewed in this audit and recover any excess unexpended funds.- Status
- Open Unimplemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 05/23/2024
- Next Update Expected
- 11/23/2024
- Legislative Related
- No
19-A-02-069.06We recommend that the State agency develop and implement procedures to ensure that the necessary staff have access to Medicaid revenue data and reconcile the data with the revenue reported on providers' fiscal reports.- Status
- Closed Implemented
- Responsible Agency
- SAMHSA
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 10/04/2021
- Legislative Related
- No
-
Missouri Claimed Some Unallowable Medicaid Payments for Targeted Case Management Services
19-A-07-067.01We recommend that the State agency refund $3,781,709 to the Federal Government for unallowable TCM claims.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $3,781,709
- Last Update Received
- 09/30/2024
- Next Update Expected
- 03/30/2025
- Legislative Related
- No
19-A-07-067.02We recommend that the State agency strengthen its policies and procedures to ensure that TCM providers maintain documentation to document that case managers are qualified to perform TCM services, TCM providers maintain documentation to support the TCM services provided, it does not pay TCM providers or claim Federal reimbursement for services that are not TCM services, and it correctly reports recoupment of TCM claims from TCM providers on its CMS-64 reports.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 09/30/2024
- Next Update Expected
- 03/30/2025
- Legislative Related
- No
-
Michigan Disbursed Only Part of Its Civil Money Penalty Collections, Limiting Resources To Protect or Improve Care for Nursing Facility Residents
19-A-05-065.01We recommend that the State agency work with organizations to fully utilize CMP collections to fund activities that protect or improve the quality of care for nursing facility resident and continue to review its process to make them more effective and efficient.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/06/2019
- Legislative Related
- No
-
Although the Centers for Disease Control and Prevention Resolved Nearly All Audit Recommendations, It Did Not Always Do So in Accordance With Federal Timeframe Requirements
19-A-07-064.01We recommend that CDC follow its policies and procedures related to the audit resolution process to ensure that all management decisions are issued within the required 6-month resolution period.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/26/2019
- Legislative Related
- No
19-A-07-064.02We recommend that CDC promptly resolve the 27 outstanding audit recommendations (33 that were past due as of September 30, 2016, less 6 resolved after the end of our audit period).- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/26/2019
- Legislative Related
- No
-
CMS Improperly Paid Millions of Dollars for Skilled Nursing Facility Services When the Medicare 3-Day Inpatient Hospital Stay Requirement Was Not Met
19-A-05-063.01We recommend that CMS ensure that when SNF claims are being processed for payment, the CWF qualifying inpatient hospital stay edit for SNF claims is enabled and operating properly to identify SNF claims ineligible for Medicare reimbursement.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/12/2021
- Legislative Related
- No
19-A-05-063.02We recommend that CMS require hospitals to provide a written notification to beneficiaries whose discharge plans include posthospital SNF care, clearly stating how many inpatient days of care the hospital provided and whether the 3-day rule for Medicare coverage of SNF stays has been met. If necessary, CMS should seek statutory authority to do so.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 11/27/2023
- Next Update Expected
- 05/29/2024
- Legislative Related
- No
19-A-05-063.03We recommend that CMS require SNFs to obtain from the hospital or beneficiary, at the time of admission, a copy of the hospital's written notification to the beneficiary and retain it in the beneficiary's medical record. If necessary, CMS should seek statutory authority to do so.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- 11/27/2023
- Next Update Expected
- 05/29/2024
- Legislative Related
- No
19-A-05-063.04We recommend that CMS require SNFs to provide written notice to beneficiaries if Medicare is expected to deny payment for the SNF stay when the 3-day rule is not met. If necessary, CMS should seek statutory authority to do so.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/10/2021
- Legislative Related
- No
19-A-05-063.05We recommend that CMS educate hospitals about the importance of explicitly communicating the correct number of inpatient days to beneficiaries and whether the inpatient days qualify subsequent SNF care for Medicare reimbursement so that beneficiaries understand their potential financial liability related to SNF care.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/24/2021
- Legislative Related
- No
19-A-05-063.06We recommend that CMS educate SNFs about their responsibility to submit accurate and valid claims for payment that are supported with documentation that clearly shows that the SNF services qualify for reimbursement.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/24/2021
- Legislative Related
- No
-
New Mexico Did Not Always Appropriately Refund the Federal Share of Recoveries from Managed Care Organizations
19-A-06-062.01We recommend that the State agency refund to the Federal Government the additional $4,421,572 Federal share related to ACA expansion recoveries and recoveries originally claimed at higher FMAPs, such as those for Family Planning and Breast and Cervical Cancer.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $4,421,572
- Last Update Received
- -
- Closed Date
- 06/18/2019
- Legislative Related
- No
19-A-06-062.02We recommend that the State agency consider conducting its reconciliations of MCO payments in a more timely manner.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/18/2019
- Legislative Related
- No
19-A-06-062.03We recommend that the State agency establish policies and procedures to identify MCO recoveries that were originally claimed at higher FMAPs.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 12/31/2019
- Legislative Related
- No
19-A-06-062.04We recommend that the State agency establish policies and procedures to ensure that it performs reconciliations of capitation payments for Community Benefit services as required under its contracts with MCOs, perform those reconciliations, and refund the Federal share of any MCO recoveries made to the Federal Government.- Status
- Closed Acceptable Alternative
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/07/2023
- Legislative Related
- No
-
Lincoln Hall Boys' Haven, an Administration for Children and Families Grantee, Did Not Always Comply With Applicable Federal and State Policies and Requirements
19-A-02-061.01We recommended that Lincoln Hall adhere to ORR and State requirements for monthly fire drills, video monitoring systems in common areas, and employee training, background investigations, health screenings, and employment qualification.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/17/2020
- Legislative Related
- No
19-A-02-061.02We recommend that Lincoln Hall implement a financial management system that identifies the source and application of Federal funds.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- $29,807,160
- Last Update Received
- -
- Closed Date
- 11/16/2020
- Legislative Related
- No
19-A-02-061.03We recommended that Lincoln Hall provide documentation to support the $29,807,160 of program costs or refund the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/16/2020
- Legislative Related
- No
19-A-02-061.04We recommended that Lincoln Hall update policies to meet applicable safety requirements for the care and release of children in its custody and maintain supporting documentation.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/16/2020
- Legislative Related
- No
19-A-02-061.05We recommend that Lincoln Hall increase oversight of its reviewing process for UAC case files to ensure that all required documentation is maintained in the file.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/16/2020
- Legislative Related
- No
19-A-02-061.06We recommended that Lincoln Hall develop policies and procedures that adhere to requirements for monitoring subrecipients and contractors.- Status
- Closed Implemented
- Responsible Agency
- ACF
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 11/16/2020
- Legislative Related
- No
-
CDC Reimbursed Contractors for Some Unallowable World Trade Center Health Program Administrative Costs
19-A-02-059.01We recommend that CDC recover the $1,046,539 associated with the 43 unallowable sampled items.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Non-Concur
- Potential Savings
- $1,046,539
- Last Update Received
- -
- Closed Date
- 04/03/2020
- Legislative Related
- No
19-A-02-059.02We recommend that CDC work with WTCHP contractors to identify and recover the remaining unallowable payments made during the audit period, which are estimated to be $7,020,012.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- $7,020,012
- Last Update Received
- -
- Closed Date
- 04/03/2020
- Legislative Related
- No
19-A-02-059.03We recommend that CDC improve its monitoring of WTCHP contractors' invoices by establishing written policies and procedures to increase oversight over the invoice approval process, and providing training to CORs regarding the review of invoices for contractor administrative costs.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/03/2020
- Legislative Related
- No
19-A-02-059.04We recommend that CDC review contractor costs for claims management services for reasonableness under Federal requirements, which could have resulted in cost savings totaling $362,324.- Status
- Closed Implemented
- Responsible Agency
- CDC
- Response
- Concur
- Potential Savings
- $362,324
- Last Update Received
- -
- Closed Date
- 04/03/2020
- Legislative Related
- No
-
TrustSolutions, LLC, Did Not Claim Some Allowable Medicare Pension Costs Through Its Incurred Cost Proposals
19-A-07-060.01We recommend that TrustSolutions work with CMS to ensure that its final settlement of contract costs reflects an increase in Medicare pension costs of $1944 for CYs 2010 and 2011.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/24/2019
- Legislative Related
- No
-
CMS Guidance to State Survey Agencies on Verifying Correction of Deficiencies Needs To Be Improved To Help Ensure the Health and Safety of Nursing Home Residents
19-A-09-058.01To help ensure the health and safety of nursing home residents, we recommend that CMS reconsider its position on permitting State agencies to certify nursing homes' substantial compliance on the basis of correction plans without obtaining evidence of correction for less serious deficiencies (deficiencies with ratings D, E, and F without substandard quality of care).- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/14/16
- Next Update Expected
- 03/30/2025
- Legislative Related
- No
19-A-09-058.02To help ensure the health and safety of nursing home residents, we recommend that CMS revise guidance to State agencies to provide specific information on how State agencies should verify and document their verification of nursing homes' correction of less serious deficiencies before certifying nursing homes' substantial compliance with Federal participation requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/14/16
- Next Update Expected
- 03/30/2025
- Legislative Related
- No
19-A-09-058.03To help ensure the health and safety of nursing home residents, we recommend that CMS revise guidance to State agencies to clarify the type of supporting evidence of correction that should be provided by nursing homes with or in addition to correction plans.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/14/16
- Next Update Expected
- 03/30/2025
- Legislative Related
- No
19-A-09-058.04To help ensure the health and safety of nursing home residents, we recommend that CMS strengthen guidance to State agencies to clarify who must attest that a correction plan will be implemented by a nursing home.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/14/16
- Next Update Expected
- 03/30/2025
- Legislative Related
- No
19-A-09-058.05To help ensure the health and safety of nursing home residents, we recommend that CMS consider improving its forms related to the survey and certification process, such as the Forms CMS-2567, CMS-2567B, and CMS-1539, so that surveyors can explicitly indicate how a State agency verified correction of deficiencies and what evidence was reviewed.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/14/16
- Next Update Expected
- 03/30/2025
- Legislative Related
- No
19-A-09-058.06To help ensure the health and safety of nursing home residents, we recommend that CMS work with State agencies to address technical issues with the ASPEN system for maintaining supporting documentation.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 12/14/16
- Next Update Expected
- 03/30/2025
- Legislative Related
- No
-
Medicare Paid Twice for Ambulance Services Subject to Skilled Nursing Facility Consolidated Billing Requirements
19-A-01-057.01We recommend that CMS redesign the CWF edits to prevent Part B overpayments to ambulance suppliers for transportation services provided to beneficiaries in Part A SNF stays.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/18/2019
- Legislative Related
- No
19-A-01-057.02We recommend that CMS direct the Medicare contractors to notify the ambulance suppliers responsible for the remaining 57,906 nonsampled beneficiary days, with potential overpayments estimated at $19.9 million, so that those suppliers can exercise reasonable diligence to investigate and return any identified overpayments, in accordance with the 60-day rule;10 and identify and track any returned overpayments as having been made in accordance with this recommendation.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $19,938,117
- Last Update Received
- -
- Closed Date
- 05/22/2020
- Legislative Related
- No
19-A-01-057.03We recommend that CMS direct the Medicare contractors to recover the portion of the incorrectly billed claims related to 78 sampled beneficiary days with payments totaling $41,456 in potential overpayments that are within the 4-year reopening period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $41,456
- Last Update Received
- -
- Closed Date
- 05/17/2019
- Legislative Related
- No
19-A-01-057.04We also recommend that CMS direct the Medicare contractors to identify ambulance suppliers that engage in a pattern of incorrect billing and refer them to OIG for possible additional enforcement action.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 03/19/2019
- Legislative Related
- No
19-A-01-057.05We recommend that CMS direct the Medicare contractors to provide guidance to ambulance suppliers on strengthening billing controls to ensure compliance with consolidated billing requirements, including obtaining confirmation of the beneficiary's Part A SNF resident status from the SNFs before billing Medicare.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/18/2020
- Legislative Related
- No
19-A-01-057.06We recommend that CMS direct its Medicare contractors to educate ambulance suppliers not to bill Medicare Part B for services they provide to beneficiaries in a covered Part A SNF stay unless the transportation was to receive services that either suspended or ended the beneficiary's SNF resident status or were related to dialysis.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/18/2020
- Legislative Related
- No
19-A-01-057.07We recommend that CMS direct the Medicare contractors to notify the ambulance suppliers responsible for the remaining portion of the $41,456 in potential overpayments that are outside of the 4-year reopening period, so that those suppliers can exercise reasonable diligence to investigate and return any identified overpayments, in accordance with the 60-day rule; and identify and track any returned overpayments as having been made in accordance with this recommendation- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $539
- Last Update Received
- -
- Closed Date
- 05/17/2019
- Legislative Related
- No
-
Medicare Compliance Review of Community Hospital
19-A-05-055.01We recommend that the Hospital refund to the Medicare contractor $22,051,602 (of which $1,266,758 was net overpayments identified in our sample) in estimated overpayments for incorrectly billed services.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $22,051,602
- Last Update Received
- -
- Closed Date
- 06/18/2019
- Legislative Related
- No
19-A-05-055.02We recommend that the Hospital exercise reasonable diligence to identify and return any additional similar overpayments received 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
- 11/08/2022
- Legislative Related
- No
19-A-05-055.03We recommend that the Hospital strengthen controls to ensure full compliance with Medicare requirements.- Status
- Open Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- 10/15/2024
- Next Update Expected
- 04/15/2025
- Legislative Related
- No
-
Kelley Medical Equipment and Supply, LLC, Received Unallowable Medicare Payments for Orthotic Braces
19-A-09-054.01We recommend that Kelley Medical refund to the DME MACs $4,079,308 in estimated overpayments for orthotic braces (of which $76,964 was overpayments identified in our sample).- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- $4,079,308
- Last Update Received
- -
- Closed Date
- 08/05/2020
- Legislative Related
- No
19-A-09-054.02We recommend that Kelley Medical 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
- 08/05/2020
- Legislative Related
- No
19-A-09-054.03We recommend that Kelley Medical obtain as much information from beneficiary medical records as it determines necessary to assure itself that claims for orthotic braces meet Medicare requirements.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 08/05/2020
- Legislative Related
- No
-
Although the Centers for Medicare & Medicaid Services Has Made Progress, It Did Not Always Resolve Audit Recommendations in Accordance With Federal Requirements
19-A-07-053.01We recommend that CMS continue to follow its policies and procedures related to the audit resolution process, and enhance them where possible, to ensure that all management decisions are issued within the required 6-month resolution period.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/01/2023
- Legislative Related
- No
19-A-07-053.02We recommend that CMS promptly resolve the 140 outstanding audit recommendations that were past due as of September 30, 2016.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 06/01/2023
- Legislative Related
- No
-
Virginia Received Millions in Unallowable Bonus Payments
19-A-04-052.01We recommend that the State agency refund $13,761,829 to the Federal Government.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $13,761,829
- Last Update Received
- -
- Closed Date
- 08/13/2019
- Legislative Related
- No
-
Rhode Island Did Not Ensure Its Managed Care Organizations Complied With Requirements Prohibiting Medicaid Payments for Services Related to Provider-Preventable Conditions
19-A-01-050.01We recommend that the State agency work with the MCOs to determine the portion of the $3,968,040 that was unallowable for claims containing PPCs and its impact on current and future year capitation payment rates.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $99,457
- Last Update Received
- -
- Closed Date
- 05/05/2020
- Legislative Related
- No
19-A-01-050.02We recommend that the State agency include a clause in its managed-care contracts with the MCOs that would allow the State agency to recoup funds from the MCOs when contract provisions and Federal and State requirements are not met; a measure that, if incorporated, could result in cost savings for the Medicaid program.- Status
- Closed Unimplemented
- Responsible Agency
- CMS
- Response
- Non-Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/30/2019
- Legislative Related
- No
19-A-01-050.03We recommend that the State agency require the MCOs to implement internal controls to prohibit payments for inpatient hospital services related to treating PPCs.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/30/2019
- Legislative Related
- No
19-A-01-050.04We recommend that the State Agency require its MCOs to review all claims for inpatient hospital services that were paid after our audit period to determine whether any payments for services related to treating PPCs were unallowable and adjust future capitation payment rates for any unallowable payments identified.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/30/2019
- Legislative Related
- No
19-A-01-050.05We recommend that the State agency strengthen its monitoring of its MCOs to ensure the MCOs comply with Federal and State requirements and its managed-care contracts relating to the nonpayment of PPCs.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 09/30/2019
- Legislative Related
- No
19-A-01-050.06We recommend that the State Agency ensure that claims identified by the MMIS information-only edit are referred back to the MCOs for appropriate correction and inclusion of missing POA codes.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 05/05/2020
- Legislative Related
- No
-
A Queens Chiropractor Received Improper Medicare Payments for Chiropractic Services
19-A-02-048.01We recommend that the Queens Chiropractor for the remaining portion of the estimated $518,821 in improper payments for claims that are outside of the Medicare reopening period, exercise reasonable diligence to identify and return improper payments in accordance with the 60-day rule, and identify any returned improper payments as having been made in accordance with this recommendation- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 02/26/2020
- Legislative Related
- No
19-A-02-048.02We recommend that the Queens Chiropractor for the remaining portion of the estimated $518,821 in improper payments for claims that are outside of the Medicare reopening period, exercise reasonable diligence to identify and return improper payments in accordance with the 60-day rule, and identify any returned improper payments as having been made in accordance with this recommendation.- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- $5,600
- Last Update Received
- -
- Closed Date
- 04/15/2019
- Legislative Related
- No
19-A-02-048.03We recommend that the Queens Chiropractor exercise reasonable diligence to identify and return any additional similar improper payments 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 Unimplemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/15/2019
- Legislative Related
- No
19-A-02-048.04We recommend that the Queens Chiropractor develop policies and procedures to ensure that any future chiropractic services billed to Medicare comply with Medicare requirements- Status
- Closed Implemented
- Responsible Agency
- CMS
- Response
- Concur
- Potential Savings
- -
- Last Update Received
- -
- Closed Date
- 04/15/2019
- Legislative Related
- No