Open Recommendations

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CDC should take further steps to ensure the quality of nursing home reporting of COVID-19 data to NHSN.

CDC should consider how quality assurance checks can be enhanced to ensure data accuracy, as appropriate.

CDC should improve the user support the NHSN Help Desk provides to nursing homes.

Risk Management

Risk Management

Supply Chain Risk Management

Identity and Access Management

Identity and Access Management

We recommend that Cahaba Government Benefits Administrators, LLC, work with CMS to ensure that its final settlement of contract costs reflects a decrease in Medicare PRB costs of $1,085,470 for CYs 2017 through 2019.

We recommend that Cahaba Safeguard Administrators, LLC, work with CMS to ensure that its final settlement of contract costs reflects a decrease in Medicare PRB costs of $9,806 for CYs 2017 through 2019.

The Under Secretary for Health ensures the identified national program office responsible for oversight of alcohol withdrawal management consider requiring the development and implementation of written guidance for the management of alcohol withdrawal across all inpatient settings, to include: (a) expectations for determining alcohol withdrawal severity, level of care, and when transfer of care is indicated; (b) expected actions of nurses to communicate with prescribers based on patients’ changes in symptoms or alcohol withdrawal severity and when that communication should be followed by a prescribers face-to-face evaluation of a patient; (c) expectations for the evaluation of co-occurring conditions, expert consultation…

The Under Secretary for Health consider the implementation of training for inpatient staff on the administration of standardized alcohol withdrawal severity scales.

Finalize and implement its Asset Forfeiture Financial Management Guide to reinforce the accounting requirements for AFP participants to adhere to timely and accurate data input to the AFP asset system, including forfeiture decisions that directly impact the recognition of revenue, and the accounting requirements for the reporting of transactions in Note 7,Forfeited and Seized Property, Net. In addition, management should more clearly define the investigative action that should be used as the seizure date for purposes of actual or constructive custody and valuation of seized property. (Updated)

Formally document the evaluation results of the out-of-period seizure analysis to include a consideration of materiality and the impact on the current and prior period financial statements. (Updated)

Re-evaluate aged seized digital assets to consider whether risks of misstatement related to accurate valuation, existence, and ownership of assets have been adequately addressed considering the evolving nature of digital asset seizures. Based on the results of the evaluation, design and implement processes, procedures, and controls to appropriately account for aged digital assets. (New)

Assess reconciliation, financial reporting review, and other monitoring controls to increase the precision with which period end financial reporting is performed, including the identification and investigation of significant variances for all financial statements. (New)

We recommend that Cahaba Safeguard Administrators, LLC, develop quality assurance procedures, to include improved policies and procedures, to ensure that going forward, it calculates Medicare segment pension assets in accordance with Federal requirements.

We recommend that Cahaba Government Benefits Administrators, LLC, work with CMS to ensure that its final settlement of contract costs reflects an increase in Medicare pension costs of $348,929 for CYs 2017 through 2019.

We recommend that Cahaba Safeguard Administrators, LLC, work with CMS to ensure that its final settlement of contract costs reflects a decrease in Medicare pension costs of $146,658 for CYs 2017 through 2019.

We recommend that Cahaba Government Benefits Administrators, LLC, decrease Medicare's share of the Medicare segment excess pension liabilities as of December 31, 2018, by $135,979 and recognize $2,111,600 as Medicare's share of the pension liabilities as a result of the benefit curtailment.

We recommend that Cahaba Safeguard Administrators, LLC decrease the Medicare segment pension assets by $94,960 and recognize $10,970,030 as the Medicare segment pension assets as of January 1, 2020.

During our performance of audit tests related to travel vouchers, we noted that 7 of the 32 travelclaims were not submitted by the traveler to the approving official within the required number ofworking days upon completion of the trip. Federal Travel Regulations §301-52.7 state that travelclaims must be submitted within five (5) working days after the traveler completes their trip orperiod of travel; or every 30 days if the traveler is on continuous travel status. We recommend theCommission clarify their commission order terms and consider delegating additional travelvoucher responsibility to travelers or reassess/implement additional procedures to improvesubmitting the travel claims…