Open Recommendations

We recommend that Alive Hospice, Inc.: • refund to the Federal Government the portion of the estimated $7,389,854 for hospice services that did not comply with Medicare requirements and that are within the 4-year reopening period

We recommend that Alive Hospice, Inc.: • based upon the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation; and

We recommend that Alive Hospice, Inc. strengthen its policies and procedures to ensure that hospice services comply with Medicare requirements.

We recommend that Ambercare Hospice, Inc. based upon the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation; and

We recommend that Ambercare Hospice, Inc. strengthen its policies and procedures to ensure that hospice services comply with Medicare requirements.

HHS should continue to work with OMB and other stakeholders to develop and implement an approach to reporting on CDC and OHS Disaster Relief improper payments in FY 2021

HHS should continue to work with OMB and other stakeholders, including considering recommendations from recent OIG audits, to develop and implement an approach to reporting on APTC improper payments in FY 2021

HHS should continue to explore a vehicle to conduct recovery audits that will fit into the larger Medicare Part C program in FY 2021

HHS should continue to follow up with States during the interim period to verify that corrective actions identified after the improper payment error rate measurement review for the Medicaid and CHIP programs are being implemented. NOTE: The current COVID-19 public health emergency may impact the ability of States to analyze and follow up on corrective action plans. Consequently, this will impact the information reported to CMS.

HHS should focus on the root causes of the improper payment percentage and evaluate critical and feasible action steps to assist States with their compliance efforts for new requirements of the Medicaid and CHIP programs

HHS should continue to work with the Office of Management and Budget and other stakeholders to develop and implement an approach to reporting on Temporary Assistance for Needy Families (TANF) improper payments in FY 2021, which will aid in identifying root causes of TANF improper payments and allow HHS to develop and report corrective action plans

Provide guidance identifying programs and/or activities as a part of its internal guidance and in accordance with achieving its mission requirements.

Align programs and/or activities with applicable reporting requirements.

Report programs and/or activities in accordance with applicable Federal criteria.

Provide training to CPSC program managers on how to develop and implement a formal internal controls program in accordance with Standards for Internal Control in the Federal Government, OMB Circular A-123, and CPSC policies and procedures.

Develop a formal internal controls program over operations for CPSC programs.

Establish formal lines of communication between the Office of Financial Management, Planning and Evaluation and CPSC program management for the purpose of assessing and monitoring internal control programs and compliance with FMFIA requirements.

Develop and incorporate metrics on the National Enforcement Investigations Center work environment and culture into Office of Criminal Enforcement, Forensics, and Training senior management performance standards, such as results from the annual Federal Employee Viewpoint Survey, periodic culture audits, or other methods to measure progress.

Develop and incorporate metrics that address work environment andculture into National Enforcement Investigations Center senior management performance standards.

Standardize acquisition and assistance award requirements to include (a) codes of conduct specific to sexual exploitation and abuse for all implementers and (b) requirements for implementers to review and certify that subimplementers establish sexual exploitation and abuse-related internal controls and codes of conduct.

Issue guidance to Agency staff on roles and responsibilities for assessing implementers' internal controls designed to protect beneficiaries from sexual exploitation and abuse when conducting pre-award risk assessments.

We recommend that the NPS coordinate with the PRSHPO to develop and implement a labor distribution report that includes all appropriate information such as employee name, project number, employee identification number, total hours worked, hours absent, hourly rate, wage earned, indirect expenses applied, and benefits accrued.

Evaluate the obstacles to implementing the Clean Water Act to controltrash in U.S. waterways and provide a public report describing those obstacles.

Develop and disseminate strategies to states and municipalities for addressing the obstacles identified in the evaluation from Recommendation 1. These strategies may include guidance regarding how to develop narrative water quality criteria, consistent assessment and measurement methodologies, and total maximum daily loads for trash pollution.

We recommend that the New York State Department of Health refund $9,325,338 to the Federal Government