Open Recommendations

The auditors recommend that the Chief Information Officer require that the Department and FSA to take immediatecorrective actions to ensure appropriate resources and funding are available and dedicated to complete implementation ofthe required EL1 and EL2 event logging maturities.

The auditors recommend that the Chief Information Officer require the Department to update Department PIA processes,quality control procedures, and monitoring controls to validate, track, and enforce the timely completion and review ofPIAs.

Develop clear guidance on running business reports out of Community Affairs Reporting and Events System, including the use of filters.

We recommend that the Kentucky Cabinet for Health and Family Services, Department for Medicaid Services file invoices for and collect from manufacturers rebates totaling $15,611,770 ($11,209,642 Federal share) for single-source and top-20 multiple-source physician-administered drugs and refund the Federal share of rebates collected.

We recommend that the Kentucky Cabinet for Health and Family Services, Department for Medicaid Services strengthen its internal controls to ensure that all eligible physician-administered drugs are invoiced for rebate.

We recommend that the Kentucky Cabinet for Health and Family Services, Department for Medicaid Services ensure that all physician-administered drugs eligible for rebates after our audit period are processed for rebates.

We recommend that the Kentucky Cabinet for Health and Family Services, Department for Medicaid Services work with CMS to determine whether the other claims for multiple-source physician-administered drugs, totaling $5,967,128 ($4,281,678 Federal share), were eligible for rebates and, if so, determine the rebates due and, upon receipt of the rebates, refund the Federal share of the rebates collected.

We recommend that Novitas Solutions, Inc., work with CMS to ensure that its final settlement of contract costs reflects a decrease in Medicare nonqualified costs of $84,291 for CYs 2016 through 2018.

Bureau for Asia coordinate with USAID/Regional Development Mission for Asia, USAID/Central Asia Regional, and USAID/Philippines, Pacific Islands, and Mongolia to review and revise each mission's procedures to incorporate guidance on integrating C-TIP during strategy, project, and activity design.

Bureau for Asia coordinate with USAID/Regional Development Mission for Asia, USAID/Central Asia Regional, and USAID/Philippines, Pacific Islands, and Mongolia to review and revise each mission's mission orders to incorporate guidance on designating C-TIP Coordinators, assigning responsibilities, and using C-TIP Coordinators. As part of this review, each mission should (1) designate C-TIP Coordinator(s) in its mission orders and (2) insert C-TIP Coordinator responsibilities into the position descriptions and annual work objectives for designated C-TIP Coordinators.

Bureau for Asia coordinate with USAID/Regional Development Mission for Asia, USAID/Central Asia Regional, and USAID/Philippines, Pacific Islands, and Mongolia to develop and implement an action plan to bring each mission's monitoring and enforcement practices for acquisition and assistance awards into compliance with trafficking in persons regulations, policies, and procedures.

We recommend that the Puerto Rico Department of Health develop written policies and procedures to use sources other than the Puerto Rico Demographic Registry to identify deceased enrollees.

We recommend that the Puerto Rico Department of Health identify capitation payments made after the audit period on behalf of deceased enrollees and refund to the Federal Government the Federal share of any unallowable payments.

We recommend that the Puerto Rico Department of Health refund $6,979,822 to the Federal Government.

We recommend that the Puerto Rico Department of Health establish a process with ASES to ensure ASES ceases making payments to MCOs on behalf of enrollees after their deaths are recorded in DOH's eligibility system and recoups unallowable payments made on behalf of deceased enrollees.

We recommend that the Puerto Rico Department of Health develop written policies and procedures to ensure that DOH staff periodically update, at least monthly, DOH's eligibility system with data on deaths recorded in the Puerto Rico Demographic Registry.

We recommend that the Puerto Rico Department of Health identify capitation payments made on behalf of enrollees with a date of death in the DMF before the month covered by the capitation payments, estimated as $885,123 in Federal Medicaid funds, and refund to the Federal Government the Federal share of any unallowable payment.

We recommend that the Substance Abuse and Mental Health Services Administration improve its policies and procedures for awarding CCBHC-E grants to ensure that clinics comply with Federal requirements by establishing required time frames to verify that clinics met certification eligibility requirements, and processes to verify whether clinics entered into agreements with DCOs to provide certain services.

We recommend that the Substance Abuse and Mental Health Services Administration improve its policies and procedures for monitoring CCBHC-E grants to ensure that clinics comply with Federal requirements by establishing processes to verify that clinics filled key personnel positions, ensured key personnel met level-of-effort requirements, timely submitted FFRs, and properly reported cash on hand.

We recommend that the Puerto Rico Department of Health establish policies and procedures with the Puerto Rico Health Insurance Administration (referred to in Spanish with acronym ASES) to ensure ASES recovers unallowable payments made on behalf of enrollees assigned more than one identification number.

We recommend that the Puerto Rico Department of Health refund $516,762 to the Federal Government.

We recommend that the Puerto Rico Department of Health strengthen its process for ensuring that no person is issued more than one identification number.

We recommend that ACF develop mitigating controls and strategies to lower the high and moderate risks we identified.

We recommend that the Centers for Disease Control and Prevention develop an action plan to enforce site visit requirements by CDC's planned date of July 1, 2023.

We recommend that the Centers for Disease Control and Prevention work with program recipients to implement a plan and timeline to: (1) conduct the required site visits that are overdue and (2) verify the completion of followup actions that had not been completed by the deadlines.