Open Recommendations

The Under Secretary for Health coordinates with VA to review the roles, responsibilities, and number of staff required for the VA and Veterans Health Administration offices involved in the development, validation, and implementation of staffing models, and ensure that staffing model-related efforts are prioritized and supported.

The Under Secretary for Health coordinates with VA to evaluate the status of, and provide a timeline for, the development, validation, and implementation of Veterans Health Administration staffing models for all occupations.

The Under Secretary for Health coordinates with VA to evaluate the status of, and provide a timeline for, the implementation of HR Smart-related requirements referenced in VA and Veterans Health Administration policy, with a specific focus on the authorizations, vacancies, budgeted positions, and unbudgeted requirements at the facility, Veterans Integrated Service Network, and national levels.

We recommend that Catholic Home Care strengthen its procedures to ensure that beneficiaries are receiving only reasonable and necessary skilled and dependent services

1. We recommend that Jewish Hospital refund to the Medicare contractor $13,486,524 in estimated overpayments for the audit period for claims that it incorrectly billed that are within the 4-year claim reopening period.

We recommend that Jewish 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 Jewish Hospital strengthen internal controls by: strengthening procedures to verify that all IRF beneficiaries meet Medicare criteria for acute inpatient rehabilitation, developing processes to ensure that procedure and diagnosis codes are supported in the medical records, providing additional training to inpatient and outpatient coding staff on the use of bypass modifiers, and developing procedures to verify that the use of bypass modifiers is supported in the medical records.

Analyze and document the justification for the FAA Contract Tower (FCT) Program's minimum staffing requirements.

Develop and implement an internal process to periodically review, and maintain supporting records for FCT controller staffing minimums.

Develop and implement an internal process"including roles and responsibilities, timeframes, and criteria"to ensure contract requirements are met, and overpayments made to contractors are recovered.

Repay Federal matching funds spent on the case that was ineligible for Federal funding.

Update the FEMA Recovery Standard OperatingProcedure, SOP 9570.24 – Strategic Funds Management – ImplementationProcedures for the Public Assistance Program, at a minimum, to: provide criteria for documentation required for subreceipients’drawdown schedule for funding projections to determine whether fundsare needed within 180 days; and require Regions document the basis for decisions and maintain supportfor these decisions in Grants Manager and in Emergency ManagementMission Integrated Environment (EMMIE).

Develop a mechanism to ensure that the Office ofResponse and Recovery monitors the implementation of the Strategic FundsManagement Initiative in accordance with policy

Finalize the Grant Operations policies and procedures to reflect the current state and post‐reorganization.

Update the testing of design and effectiveness attributes to be consistent with the new policies and procedures.

Assess and document the known errors in the Trust Model and whether or not they could lead to material misstatements if not corrected. Document the rationale and procedures used to correct the data in the Trust Model.

The Office of Programs should ensure that the Disability Benefits Division works with Policy and Systems to implement system modifications to D-BRIEF to ensure that the Disability Briefing Document for decisions changed from occupational to total and permanent disabilities do not contain the incorrect statement that the (railroad) employee (applicant) was rated using Independent Case Evaluation.

We recommend that the Centers for Medicare & Medicaid Services review the findings in this report and, if it determines that a separate payment methodology for capital costs at new hospitals is no longer warranted, change its regulations to require new hospitals to have their Medicare capital costs paid through the IPPS with an option for payment adjustments or supplemental payments if necessary

Develop and implement a plan to increase fraud referrals from the Medicaid agency and other sources.

Revise its MOU with the Mississippi Division of Medicaid to reflect current law.

Repay Federal matching funds spent on cases that were ineligible for Federal funding.

Develop a procedure to ensure that it reports all program income properly on its Federal financial reports.

Work with the Mississippi Division of Medicaid to ensure the return of the Federal Government's share of all recoveries.

We recommend that the Oklahoma Health Care Authority consider whether more of an emphasis on counseling could improve OUD outcomes and, if so, take steps to increase the appropriate use of counseling with OUD drugs in outpatient OUD treatment

We recommend that the Oklahoma Health Care Authority develop policies and procedures to ensure that Medicaid behavioral health services are reviewed on an ongoing basis.