Open Recommendations

ACF should proactively provide technical assistance to States that face challenges in appointing a GAL for every child victim.

ACF should proactively identify and address obstacles that States face in reporting complete and accurate GAL data.

Monitor facility compliance with the use of an approved inventory management system for completeness and accuracy.

Establish standardized systems and requirements for facility staff to appropriately record necessary biologic implant attributes for accurate and accessible tracking of recipients to advance patient safety.

We recommend the Principal Deputy Assistant Secretary for Occupational Safety and Health. Compare remote inspections to onsite inspections, and at a minimum provide analysis that addresses their frequency and timeliness for identifying and abating worksite hazards.

We recommend that Brookdale Home Health, LLC strengthen its procedures to ensure that: the homebound statuses of Medicare beneficiaries are verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented and beneficiaries are receiving only reasonable and necessary skilled services

We recommend that Blue Cross Blue Shield of Michigan: We recommend that Blue Cross Blue Shield Michigan refund to the Federal Government the $14,534,375 of net overpayments.

We recommend BCBSM identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before or after our audit period and refund any resulting overpayments to the Federal Government.

We recommend that BCBSM examine its existing compliance procedures to identify areas where improvements can be made to ensure diagnosis codes that are at high risk for being miscoded comply with Federal requirements (when submitted to CMS for use in CMS’s risk adjustment program) and take the necessary steps to enhance those procedures.

Update the Changed Product Rule to address the integration of technological advances and exceptions.

Conduct an assessment to determine how frequently unit members serve as both the company engineer involved in a design as the applicant and also find compliance on FAA's behalf on that same design. Based on the results of this assessment, revise ODA guidance to strengthen controls in this area.

Evaluate criteria for determining whether a system meets the definition of a "novel or unusual design feature," add specificity, and implement identified improvements.

Establish and implement communication and coordination procedures between Boeing and FAA, and within FAA among flight test, certification, and Flight Standards.

Establish and implement policies and procedures for the AircraftEvaluation Group related to its role in the certification process that require,at a minimum: formal documentation of approvals; documentation of operationalflight test parameters, procedures, and outcomes; expanded written guidance onthe FSB process; and improved consistency of procedures between AEG offices.

Incorporate lessons learned from the Boeing 737 MAX accidents into the ODA oversight process guidance implementing a risk-based approach.

Clarify priorities, roles, and responsibilities for FAA engineers regarding oversight and certification work, including the timing of when oversight should be performed.

We recommend the Principal Deputy Assistant Secretary of Employment and Training establish effective controls, in collaboration with SWAs, to mitigate fraud and other improper payments to ineligible claimants, including the areas identified in the memorandum: UI benefits paid to multi-state claimants, claimants who used the social security numbers of deceased individuals, potentially ineligible federal inmates, and claimants with suspicious email accounts. Effective controls will help prevent similar or greater amounts of fraud and allow those funds to be put to better use.

We recommend the Principal Deputy Assistant Secretary of Employment and Training work with Congress to establish legislation requiring SWAs to cross match high-risk areas, including the four areas identified in the memo.

We recommend that Tidewell strengthen its policies and procedures to ensure that hospice services comply with Medicare requirements.

CMS should conduct targeted reviews of MS-DRGs and stays that are vulnerable to upcoding, as well as the hospitals that frequently bill for them.

We recommend that BAO establish procedures to monitor and evaluate IHS Direct programs’ use of no-year Health Services funds carried forward by appropriation year and budget activity program.

(U) Rec. 1.c: Recommendation is Classified.

(U) Rec. 1.d: Recommendation is Classified.

(U) Rec. 1.j: Recommendation is Classified.

(U) Rec. 2.b: Recommendation is Classified.