Inspector General Open Recommendations
08/30/2019 - Department of Health & Human Services New Jersey Did Not Bill Manufacturers for Tens of Millions of Dollars in Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations Audit - Open Recommendations
08/30/2019 - Department of Health & Human Services Florida Medicaid Paid Hundreds of Millions in Unallowable Payments to Jackson Memorial Hospital Under Its Low Income Pool Program Audit - Open Recommendations
We recommend that the State agency refund $411,932,576 to the Federal Government, consisting of: o $64,382,543, representing the Federal share of net Hospital self-reported LIP overpayments for the audit period and o $347,550,033, representing the Federal share of LIP cost limits calculated by the Hospital that did not comply with Federal and State requirements as identified in this audit.
We recommended that the State agency revise its LIP instruction manual to instruct participant hospitals to perform the following steps when preparing the LIP cost-limit calculations: o exclude the cost of non-emergency care for undocumented aliens; o exclude the cost of caring for prisoners in other than an inpatient setting; o review section 6 costs for allowability based on the RFMD; o distribute low-income patient days and ancillary charges to cost centers consistent with the Medicare cost report; o review the calculations for clerical errors and ensure that they exclude noncompliant items; and o reduce calculated costs by all payments received including: ¿- Medicaid payments that do not relate to specific claims; ¿- the portion of Medicare cost report settlements, direct graduate medical education, bad debts, and organ acquisition cost payments that relate to Medicare dual-eligible patients.
We recommended the State agency improve its oversight of the LIP program by establishing policies and procedures for: o providing additional training to its staff members on the RFMD and STCs for the waiver; o providing training to participating hospital personnel on LIP program compliance and preparing the cost-limit calculations; and o monitoring hospital LIP calculations to verify that they comply with the RFMD and STCs including: ¿- reconciling hospital cost-limit calculations to the finalized Medicare cost reports; ¿- reviewing hospital low-income data to verify that it does not include data for undocumented aliens; ¿- reviewing hospital low-income data to verify that it does not include data for prisoners in other than an inpatient setting; ¿- testing or verifying the accuracy and completeness of the data being used by hospitals in their LIP cost-limit calculations; ¿- reviewing hospital cost-limit calculations to verify that the hospitals properly incorporate observation days and charges into the calculations, as prescribed by the RFMD; ¿- reviewing organ acquisition costs to verify that hospitals use the RFMD-required methodology and to verify the accuracy of the data used in the calculations; ¿- establishing electronic edits in the cost-limit calculation template to detect distribution errors in which low-income costs exceed total costs for individual cost centers; and ¿- reviewing section 6 costs claimed by hospitals to verify allowability based on the RFMD.
08/30/2019 - Department of Health & Human Services Colorado Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries Audit - Open Recommendations
Improve the accuracy of manually input case actions by: o providing eligibility caseworkers with clear policies, procedures, and guidance on eligibility determinations that comply with Federal and State requirements and that address, among other things, income calculations and parent and caretaker definitions, o providing training to and monitoring of caseworkers to improve manual input accuracy, and o implementing a process to identify and review manually input eligibility data;
Redetermine, as appropriate, the current Medicaid eligibility status of the sampled beneficiaries who did not meet Federal and State eligibility requirements, with specific attention to: o beneficiaries who did not meet income requirements, o beneficiaries who were eligible under a mandatory Medicaid eligibility group, o beneficiaries who did not meet citizenship requirements, and o beneficiaries who were not eligible for the new adult group but for whom the State agency claimed enhanced Federal Medicaid reimbursement;
Improve the CBMS to ensure that: o it verifies income and determines eligibility by using available electronic data sources on a timely basis, o it has system functionality to terminate Medicaid coverage for beneficiaries who do not provide satisfactory documentation to resolve a citizenship discrepancy after the reasonable opportunity period ends, o the coding errors affecting eligibility determinations are identified and addressed in a timely manner, and o it has the ability to verify income that is self-attested by beneficiaries on a timely basis and through multiple sources, to include one-to-one employer matches
08/29/2019 - Export-Import Bank Evaluation of Risk Management Procedures and Chief Risk Officer Responsibilities Inspection / Evaluation - Open Recommendations
To clarify the authority and responsibility of the CRO with respect to the current allocation of risk management responsibilities across the agency, EXIM Bank should formally document the risk management roles, responsibilities and authority of its line of defense functions; clarify responsibilities and interaction between different senior management committees and divisions; identify the individuals and functions to be responsible for each; and address any gaps in those responsibilities.
08/29/2019 - Social Security Administration Security of the Social Security Administration’s Cloud Environment Audit - Open Recommendations
08/28/2019 - Internal Revenue Service Criminal Investigation Should Increase Its Role in Enforcement Efforts Against Identity Theft Audit - Open Recommendations
08/28/2019 - Internal Revenue Service Billions of Dollars of Potentially Erroneous Carryforward Claims Are Still Not Being Addressed Audit - Open Recommendations
The Commissioner, Small Business/Self-Employed Division, should identify and examine returns with discrepancies of General Business Credit carryforward claims. Based on the results of examining these returns, determine if examination criteria should be expanded to include all business and individual carryforward claims containing discrepancies.
08/28/2019 - Department of Health & Human Services Oceanside Medical Group Received Unallowable Medicare Payments for Psychotherapy Services Audit - Open Recommendations
We recommended that Oceanside Medical Group, for the remaining portion of the estimated $2,694,446 overpayment for claims that are outside of the 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.