Open Recommendations

We recommend that the Louisiana Department of Health advise nursing homes to contractually require staffing companies to conduct background check searches that include State police records and to adjudicate the results of background checks in accordance with Federal and State requirements.

We recommend that the Louisiana Department of Health advise nursing homes to ensure that all background checks are conducted by authorized agencies and include a search of State police records.

We recommend that the Louisiana Department of Health conduct routine monitoring of nursing homes' compliance with background check requirements.

We recommend that the Louisiana Department of Health make training or informational material available to nursing homes on the applicable Federal and State regulations for background checks of employees.

(U) Rec. 1: The DoD OIG recommended that the Director of the Defense Health Agency identify all specialties, by location, where the managed care support contractor provider network is not meeting DoD access to care standards and, in coordination with the managed care support contractors, develop and implement a plan to bring those provider networks into compliance with the DoD access to care requirements.

(U) Rec. 2.a: The DoD OIG recommended that the Director of the Defense Health Agency, in coordination with the Service Surgeons General, conduct a survey of TRICARE beneficiaries, civilians, and contractors stationed overseas about their access to health care services. The survey should, at a minimum, include the following: i. the overseas locations that have a relatively high number of beneficiaries with concerns about their access to health care. ii. the clinical specialties in overseas locations that beneficiaries have the greatest difficulty accessing. iii. the reasons beneficiaries have difficulties obtaining access to health care in each location and for each…

(U) Rec. 2.c: The DoD OIG recommended that the Director of the Defense Health Agency, in coordination with the Service Surgeons General, use the results of the surveys to develop and implement a plan to address the identified issues.

We recommend that the Assistant Secretary for OESE ensures that SSA develops, finalizes, and implements writtenguidance and review procedures for staff involved in reviewing and approving alternate assessment waiver and waiverextension requests, to include Steps for SSA staff to verify assessment participation rates (even if this would need tooccur after requests are approved) and actions to be taken if discrepancies are noted; expectations for how staff shoulddocument communication with States during the review process; expectations for how staff should document their reviewand analysis of requirements in the internal memo to clearly show how a State met or did not meet…

We recommend that the Assistant Secretary for OESE ensures that language in the Department’s annual memos toStates with regard to LEA verifications aligns with language included in the regulations to eliminate confusion and clarifyexpectations regarding what information should be included in requests to ensure compliance with State assurance andsubstantial progress requirements, to include specifically addressing progress made on each component of their prioryear plan and timeline.

To help ensure indirect funded minor construction projects within Science are in accordance with applicable laws, regulations, Science’s and ANL’s policies and procedures, and Department guidance, we recommend that the Deputy Director for Operations, Science, ensure:1. Indirect funded minor construction projects are reviewed thoroughly by the cognizant site office, using financial subject matter expertise from the Consolidated Service Center as necessary, to make fully informed decisions and verify compliance with Science’s funding guidance;

To help ensure indirect funded minor construction projects within Science are in accordance with applicable laws, regulations, Science’s and ANL’s policies and procedures, and Department guidance, we recommend that the Deputy Director for Operations, Science, ensure:2. The relevant Science policies and processes are updated to reflect that proposed minor construction projects include supplemental materials needed for the Department’s review.

To help ensure indirect funded minor construction projects within Science are in accordance with applicable laws, regulations, Science’s and ANL’s policies and procedures, and Department guidance, we recommend that the Deputy Director for Operations, Science, ensure Argonne Site Office Designated Officials document reasons for changes in proposed funding sources for minor construction projects.

To help ensure indirect funded minor construction projects within Science are in accordance with applicable laws, regulations, Science’s and ANL’s policies and procedures, and Department guidance, we recommend that the Deputy Director for Operations, Science, ensure Argonne Site Office Designated Officials review Science processes to assure validation of scope within an indirect funded minor construction project and appropriate alignment with a common purpose and benefiting base.

To increase transparency and visibility in reviewing and approving indirect funded minor construction projects, we recommend that the Acting Manager, Argonne Site Office, in coordination with the Division Director, ANL’s Project Management Organization: review Science’s updated policies and procedures to assure adequate project information is submitted to Department officials to enable sufficient review and verification of indirect funded minor construction projects prior to approval.

The relevant Science policies and processes are updated to reflect that proposed minor construction projects include supplemental materials needed for the Department’s review.

Review Science’s updated policies and procedures to assure adequate project information is submitted to Department officials to enable sufficient review and verification of indirect funded minor construction projects prior to approval.

We recommend that SelectCare of Texas, Inc. identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before and after our audit period and refund any resulting overpayments to the Federal Government

We recommend that SelectCare of Texas, Inc. refund to the Federal Government the $482,601 in net overpayments

We recommend that SelectCare of Texas, Inc. review its existing compliance procedures to identify potential areas where improvements can be made to ensure that diagnosis codes that are at high risk for being miscoded comply with Federal requirements (when submitted to CMS for use in CMS's risk adjustment program) and take any necessary steps to enhance those current procedures

We recommend that CMS continue to explore opportunities for using T-MSIS and SSA's DMF data to improve its oversight of the Medicaid program. Specifically, CMS should develop a process to match enrollment and payment information in T-MSIS with the DMF and provide the results of that match to States to help reduce Medicaid capitation payments made to MCOs on behalf of deceased enrollees.

We recommend that CMS ensure that states complete actions on our remaining recommendations to address the internal control weaknesses we indentified.

We recommend that CMS collect the outstanding unallowable payments totaling the estimated $41,003,804 we previously identified.

OIG recommends that the Bureau of Administration, in coordination with the Bureau of Overseas Buildings Operations, issue a directive (1) emphasizing the requirement to comply with Federal Acquisition Regulation 36.605(b), which states that access to information concerning the independent government cost estimate shall be limited to government personnel whose official duties require knowledge of the estimate and (2) underscoring accountability and identifying penalties for noncompliance.

OIG recommends that the Bureau of Administration, in coordination with the Bureau of Overseas Buildings Operations, develop, implement, and communicate a process to ensure that new work that is not within the general scope of the contract or task order is treated as a new procurement, preventing out-of-scope modifications, as required by federal regulations and Department requirements.

OIG recommends that the Bureau of Administration, in coordination with the Bureau of Overseas Buildings Operations, issue a directive (1) emphasizing that acquisition planning and market research are completed and documented prior to initiating new projects at overseas posts, as required by federal regulations and Department of State requirements, and (2) underscoring accountability and identifying penalties for noncompliance.