Open Recommendations

We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to do the following: Recover $11,399 in overpayments made to suppliers for the 15 sample items that did not meet Medicare requirements.

We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to do the following: Perform additional medical reviews of claims for intermittent urinary catheters and sterile catheter kits, which could have saved Medicare an estimated $35,079,833 for our audit period.

We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to do the following: Provide additional education to suppliers on documenting eligibility for intermittent urinary curved-tip catheters and sterile catheter kits and on documenting refills of catheters and sterile catheter kits. For example, CMS could emphasize the following:

-Medical records that list only a diagnosis without adequate documentation of an enrollee's inability to use a straight-tip catheter are insufficient to support medical necessity for use of a curved-tip catheter.

-Notations of urinary tract infections in medical records are insufficient to support that an enrollee is eligible for…

We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to recover $11,399 in overpayments made to suppliers for the 15 sample items that did not meet Medicare requirements.

We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to perform additional medical reviews of claims for intermittent urinary catheters and sterile catheter kits, which could have saved Medicare an estimated $35,079,833 for our audit period.

We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to provide additional education to suppliers on documenting eligibility for intermittent urinary curved-tip catheters and sterile catheter kits and on documenting refills of catheters and sterile catheter kits.

We recommend that NRC management investigate methods of identifying inactive user accounts and improving its internal controls over inactivity to ensure that it disables network user accounts after 90 days of inactivity.

The Office of General Counsel should update the Watch List procedures to include examples of risks warranting mitigating measures and what mitigating measures can be applied to parties when there is a match.

The Office of General Counsel should update the Watch List procedures to include examples of a suspicion and reputation of untrustworthy behavior and to add parties based on referrals from other agencies.

We recommend that USAID's Office of Acquisition and Assistance Cost, Audit and Support Division/Contract Audit Management Branch determine the allowability of the $42,764 ineligible questioned costs on pages 25 to 37 of the audit report and recover any unallowable amount.

We recommend that USAID's Office of Acquisition and Assistance Cost, Audit and Support Division/Contract Audit Management Branch Verify that Yayasan Project HOPE corrects the seven instances of material noncompliance detailed on pages 25 to 37 of the audit report.

We recommend that APHIS identify and correct the RBIS algorithm to ensure inspection due dates are properly calculated and recorded in eFile.

We recommend that APHIS establish and provide additional training on dog breeder inspections to inspectors and supervisors, to include proper classification of NCIs and required inspection procedures for dog breeders.

We recommend that APHIS develop and implement a process to ensure that inspectors are consistent throughout their inspection of the dog breeder’s facility to reduce the occurrence of missed items for review.

We recommend that APHIS establish a formal process to track and review open complaints to ensure all complaints are closed prior to the established deadlines. If the complaint is not closed by the deadline, APHIS should ensure reasons are documented in eFile.

We recommend that APHIS perform a risk assessment of the complaint process to evaluate and determine whether APHIS has correctly prioritized resources to manage the identified risks. We also recommend APHIS implement additional processes as necessary to ensure adequate coverage.

Establish a mechanism to ensure that groups with disaster recovery responsibilities prioritize and enforce the company’s strategy and effectively communicate and coordinate with each other.

For each OT system, develop, document, and implement a comprehensive disaster recovery plan that includes a process to keep the plan current.

Develop and begin implementing a technology refresh plan with milestones for replacing outdated OT devices.

Review and take appropriate actions for the 30 beneficiaries we identified who had improper payments.

Obtain accurate WC data for the 357 beneficiaries with missing or inaccurate WC information, make necessary payment adjustments, and resolve any improper payments, if necessary.

We recommend the Vice President and Chief Information and Digital Officer, Technology and Innovation, (1) design and implement a documented process for maintaining an accurate inventory of internet accessible internet protocal addresses and update Cybersecurity and Infrastructure Security Agency within five days of changes.

We recommend the Vice President and Chief Information and Digital Officer, Technology and Innovation, update patch management processes to verify known exploited vulnerabilities are patched or mitigated in accordance with policy.

Require Carrington to remedy HUD and the 27 borrowers in our sample with improper foreclosure filings and take administrative actions if appropriate.

Require Carrington to perform a review of loans affected by the system errors and when appropriate, remedy the borrowers or HUD.