Open Recommendations

We recommend that the Office of Programs strengthen its controls over the penalty calculation process and the accuracy of supporting data by updating the RL-331, Notice of Change in Health Insurance Election to include a penalty calculation summary that explains how and why the penalty rate was calculated and includes the applicable calculation decision elements, such as the dates of employment, GHP coverage period, SBI Income Related Monthly Adjustment Amount, birthdate, retirement date, penalty period start and end dates, and the total monthly premium to enable the beneficiary to understand the reason for the penalty decision and how it was…

We recommend that the Office of Programs strengthen its controls over the penalty calculation process and the accuracy of supporting data by establishing a penalty and refund review process to include both the standard form worksheet and USTAR tracking. The worksheet and supporting calculation and documentation should be reviewed, authorized, and dated by a second claims examiner and/or supervisor (if over 100 percent) on the worksheet, and tracked within USTAR. The review authorization should attest to the accuracy and completeness of the penalty or refund calculation, electronic filing of supporting documents, and beneficiary notification and confirmation.

We recommend that the Office of Programs strengthen its controls over the penalty calculation process and the accuracy of supporting data by strengthening the management control review process over Medicare premium penalty and refund authorizations by determining the reasons for the undetected errors identified during the audit and modifying the review process as needed to improve the detection and reporting of similar future errors.

We recommend that the New Jersey Department of Human Services improve its monitoring and follow-up activities to ensure that its MCOs comply with Federal and State requirements detailed in its contracts with the MCOs for providing services to beneficiaries according to personalized care plans and actively coordinating, monitoring, and documenting beneficiaries’ physical health, behavioral health, and long-term-care needs.

We recommend that the New Jersey Department of Human Services take actions, including imposing corrective action plans, fines, or other financial disincentives on MCOs, to address the MCOs’ noncompliance affecting $721 million ($386 million Federal share) in capitation payments in CY 2016 and ensure future compliance with contract requirements.

Identify the optimum Strategic Petroleum Reserve configuration and capabilities for the present and future needs of the United States.

Ensure that the Life Extension – Phase II project’s scope and completion criteria corresponds with the optimum Strategic Petroleum Reserve configuration.

Identify the optimum Strategic Petroleum Reserve configuration and capabilities for the present and future needs of the United States.

Ensure that the Life Extension – Phase II project’s scope and completion criteria corresponds with the optimum Strategic Petroleum Reserve configuration.

The Office of Aviation Analysis develop a process to regularly collect, maintain, and use information from airlines' website disclosures of all fees charged for optional or ancillary services as a screening mechanism for significant changes in these fees. For each mainline carrier and posted fee, this information should include"but not necessarily be limited to"identification of the type of each service and its price (or price range).

We recommend that The Ohio State University Hospital based on 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

We recommend that The Ohio State University Hospital strengthen controls to ensure full compliance with Medicare requirements; specifically, ensure that all IRF beneficiaries meet Medicare criteria for acute inpatient rehabilitation; all inpatient beneficiaries meet Medicare criteria for inpatient hospital services; diagnosis and discharge status codes are supported in the medical records and staff are properly trained, and medical records accurately document the appropriate number of units and distinct procedural services and that staff are properly trained.

In coordination with the assistant administrator for Mission Support,complete the development and implementation of the electronic clearance system for scientific products across the Agency.

With the assistance of the Scientific Integrity Committee, finalize and release the procedures for addressing and resolving allegations of a violation of the Scientific Integrity Policy, and incorporate the procedures into scientific integrity outreach and training materials.

With the assistance of the Scientific Integrity Committee, develop and implement a process specifically to address and resolve allegations of Scientific Integrity Policy violations involving high profile issues or seniorofficials, and specify when this process should be used.

The Acquisition Program Management Assistant Administrator to develop an effective monitoring strategy and implementation plan, including necessary policies and procedures for ensuring probability of detection through defined continued monitoring and assessment of the deployed AIT system.

We recommend that Retirement Services develop and implement additional cost effective corrective actions, aimed at the root cause(s) of improper payments, to further reduce the improper payments rate.

We recommend that the Assistant Secretary for the Office of Elementary and Secondary Education require Texas to require Houston to return to the Restart grant $34,065 in personnel expenditures that it charged for four teachers whose extra duty work was not for the purposes of the grant.

We recommend that the Assistant Secretary for the Office of Elementary and Secondary Education require Texas to review a random, statistically valid sample of the remaining payroll expenditures for teachers whose extra duty pay Houston charged to the Restart grant, determine whether the personnel expenditures were allowable under the grant, and require Houston to return funds to the grant for unallowable costs

We recommend that the Assistant Secretary for the Office of Elementary and Secondary Education require Texas to provide additional guidance to ESCs providing equitable services and assistance to nonpublic schools that specifies how to handle items purchased by nonpublic schools using Federal funds. The instructions should ensure that the appropriate public agency holds the title to materials and equipment.

We recommend that the Assistant Secretary for the Office of Elementary and Secondary Education require Texas to verify transfer of the title for the materials and equipment purchased by the Region 4 ESC on behalf of nonpublic schools using Restart program funds or require the ESC to return funds to the grant for unallowable costs.

We recommend that the Assistant Secretary for the Office of Elementary and Secondary Education require Texas to review the other ESCs that are providing equitable services and assistance to nonpublic schools to ensure that the ESCs have maintained control and ownership to materials and equipment purchased using Restart program funds.

We recommend that the Bureau of Fiscal Operations perform a reconciliation of Railroad Retirement Act overpayments recapture source data to the Financial Management Integrated System when preparing the payment recapture data worksheet to ensure accurate information is published in the Railroad Retirement Board's Performance and Accountability Report's payment integrity section.

We recommend that the Office of Programs create and submit proposals to Office of Management and Budget during their next budget submission that will bring the agency into compliance. If the Director of Office of Management and Budget determines that additional funding would help the agency become compliant, the agency should obligate an amount of additional funding determined by the Director of Office of Management and Budget to intensify compliance efforts.