Open Recommendations

We recommend that OPM modify or add language to all FFS and ER-HMO FEHBP contracts requiring PBMs or providers under a Large Provider Agreement, who provide services or supplies related to benefit administration, to have an FWA program that meets the OPM contract and CL 2017-13 requirements.

We recommend that OPM modify the ER-HMO and FFS contracts to require that vendors under Large Provider Agreements return all FWA-related recoveries to the carrier within 30 days, whereby carriers must deposit these recoveries into their working capital or investment account within 30 days. Once deposited into one of these accounts, the carrier must return the recoveries to the contingency reserve fund.

We recommend that OPM modify Section 2.3(g) and 2.3(g)(ii) to provide expectations for how carriers are to proactively identify overpayments and to define what it means by egregious errors.

We recommend that OPM modify Section 2.3(g) requring carriers to report on their collection efforts, including how promptly the carrier initiated collection once the erroneous payment was identified and the causes of the claim payment errors.

We recommend that OPM review the current recovery process in Section 2.3(g)(1) through (5) and consider whether the use of benefit offsets, after the first written notification is sent, would be more cost efficient.

We recommend that OPM modify FEHBP contracts to clarify the Agency's authority to recoup projected improper payments identified by statistical sampling.

We recommend modifying Section 2.6(g), in the amendment to the Coordination of Benefits section of the FFS contract, to allow for the recovery of low dollar claims that result from claims system errors.

We recommend the Assistant Secretary for Mine Safety and Health: Provide training on how to determine the subsequent inspection when multiple inspections overlap, enter violations into the system in the same chronological order identified, be specific when writing the “Area or Equipment” entry, and when it is appropriate to list “No area affected” for an order.

We recommend the Assistant Secretary for Mine Safety and Health: Update system controls to improve compliance of MSHA violations with the Mine Act and MSHA guidance in the following instances: a. Verify only authorized violation types used; b. Include all required phrases automatically in the “Condition or Practice” entry when the inspector selects 103(a) citations, 104(g)(1) orders, 104(e)(1)/104(e)(2) orders, or 107(a) orders; c. Ensure 104(d) orders and 104(g)(1) orders cite eligible CFR sections; d. Verify the correlations between the CFR or Mine Act sections of 104(b) orders and the original violation; e. Verify 104(d)(1) orders, 104(d)(2) orders, 104(e)(1) orders, and…

We recommend the Assistant Secretary for Mine Safety and Health: Improve the violations termination process by decreasing the percentage of future untimely terminations, improving the use of 104(b) orders, and not allowing due dates to be extended unless for specific, justified reasons listed on the violation form.

We recommend the Assistant Secretary for Mine Safety and Health: Develop a metric to measure performance and an internal control to verify timely uploading of violations from the inspector’s laptop/tablet into MCAS.

We recommend the Assistant Secretary for Mine Safety and Health: Complete periodic reviews to determine whether MSHA personnel are meeting the timely upload and recording of violations in MCAS, terminating violations by the due date, and effectively using 104(b) orders.

We recommend the Assistant Secretary for Mine Safety and Health: Work with the Solicitor’s Office and the Federal Mine Safety and Health Review Commission to implement a process to ensure violations listed in settlement agreements or court decisions still comply with the Mine Act and Mathies test.

We recommend the Assistant Secretary for Mine Safety and Health: Update the Citation and Order Writing Handbook to clarify situations when multiple safeguards can be issued for a single mine and to correct any examples that do not comply with the instructions listed in the Handbook.

1. We recommend that Sunrise Hospital & Medical Center refund to the Medicare contractor $23,606,895 ($23,615,809 less $8,914 that the Hospital has already repaid) in net estimated overpayments for the audit period for claims that it incorrectly billed that are within the 4-year reopening period.

3. We recommend that Sunrise Hospital & Medical Center strengthen controls to ensure that: (1) all IRF beneficiaries meet Medicare criteria for acute inpatient rehabilitation and all required documentation is included in the medical records, (2) all inpatient beneficiaries meet Medicare requirements for inpatient hospital services, (3) outlier payments are calculated correctly by billing the correct units of service and charges on the claim and staff are properly trained, (4) the use of bypass modifiers is supported in the medical records and staff are properly trained, and (5) HCPCS codes are supported in the medical records and staff are properly…

We recommend that the BIA Division of Facilities Management and Construction ensure all funded and required minor improvement and repair projects have been completed and identify how much of the carried over $442,632 in restricted minor improvement and repair funds can and should be used to reconcile costs improperly paid from the BIE operations and maintenance fund.

We recommend that the DOI select and implement a CDM SWAM tool that is compatible with the DOI's computer environment.

We recommend that the DOI establish, implement, and continuously review and update approved software lists (blacklists and whitelists) to ensure that unapproved, unsupported, or potentially malicious software is not present on bureau computer networks.

Enforce standard operating procedures requiring clearly defined performance goals and include performance targets in all future SBDC and WBC cooperative agreements and grants to objectively measure performance results

Collect and analyze the CARES Act entrepreneurial development cooperative agreement recipient’s performance results and establish a framework for setting goals for technical assistance programs in response to future disasters. Retain the analysis in program files for future guidance.

We recommend the Executive Associate Director of Enforcement and RemovalOperations direct the Phoenix Enforcement and Removal Field Officeresponsible for LPCC to: Ensure compliance and remedial action is taken toaddress LPCC’s use of force incidents and allegations of detainee mistreatmentby staff when warranted.

Disallow the $592,737 in questioned match costs to recover the $254,014 in Federal costs from LearningWorks for the program years 2017 and 2018 due to inadequate documentation to support its in-kind match contributions: donated classroom and office space, and teaching and administrative staff hours;

Conduct an assessment of LearningWorks’ match contribution for its third-year funding to determine whether it met its match requirement, disallow any unsupported match contributions and recover any Federal funds that were overpaid as a result of LearningWorks’ failure to meet its match requirements.

Oversee the Maine Commission when coordinating with LearningWorks to revise its policies to define supporting documentation for the usage and valuation of donated spaces for in-kind contributions;