Open Recommendations

We recommend that the Oregon Health Authority provide additional guidance to CCOs on monitoring subcontractors.

We recommend that the Oregon Health Authority take actions to ensure that CCOs do not subcontract the adjudication of final appeals.

We recommend that the Oregon Health Authoritytake actions to ensure that the data that CCOs submit on grievances and appeals in the grievance workbooks are accurate and complete.

We recommend that the Connecticut Department of Social Services work with CMS to review Medicaid payments made to HPS after our audit period and refund any overpayments.

We recommend that the Connecticut Department of Social Services strengthen its oversight of the SBCH program by working with DAS to develop a detailed review process for claims submitted by the LEAs to ensure that all claims meet Federal and State requirements.

We recommend that the Connecticut Department of Social Services refund $761,179 to the Federal Government.

Implement controls, such as systems alerts and management reports, to identify beneficiaries in miscellaneous suspense status and ensure employees take corrective actions timely.

Include a Numident match in the Death Information Processing System, or similar process, to assess Online Verification System discrepancies before rejecting an Electronic Death Registration report.

We recommend that the North Carolina Department of Health and Human Services follow up with the 18 nursing homes to verify that corrective actions have been taken. regarding the life safety and emergency preparedness deficiencies identified in this report;

We recommend that the North Carolina Department of Health and Human Services work with CMS to develop life safety training for nursing home staff.

We recommend that the North Carolina Department of Health and Human Service conduct more frequent site surveys at nursing homes with a history of multiple high-risk deficiencies.

We recommend that the North Carolina Department of Health and Human Service work with LEM agencies to develop a process to monitor the submission of emergency plans.

5. We recommend that the North Carolina Department of Health and Human Services increase collaboration with LEM agencies to: clarify roles and responsibilities; make them aware of pending, or newly licensed, nursing homes in their counties; provide LEM agencies with survey results, to the extent possible, from individual nursing homes to identify specific vulnerabilities.

6. We recommend that the North Carolina Department of Health and Human Services increase collaboration with RHCs and communication with nursing home administrators to ensure nursing homes are aware of resources available to them.

We recommend that the Vermont Agency of Human Services, Department of Vermont Health Access refund to the Federal Government $357,706 (Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement.

We recommend that the Vermont Agency of Human Services, Department of Vermont Health Access refund to the Federal Government $47,389 (Federal share) for claims for top-20 multiple-source physician-administered drugs that were ineligible for Federal reimbursement.

We recommend that the Vermont Agency of Human Services, Department of Vermont Health Access • work with CMS to determine the unallowable portion of $78,363 (Federal share) for other claims for multiple-source physician-administered drugs that may have been ineligible for Federal reimbursement, refund that amount, and consider invoicing drug manufacturers for rebates for these drugs if CMS determines that the drug claims are allowable.

We recommend that the Vermont Agency of Human Services, Department of Vermont Health Access work with CMS to determine and refund the unallowable portion of Federal reimbursement for physician-administered drugs that were not invoiced for rebates after December 31, 2017.

We recommend that the Vermont Agency of Human Services, Department of Vermont Health Access strengthen its internal controls to ensure that all physician-administered drugs eligible for rebates are invoiced.

We recommend that Southwest Key Programs implement procedures to review leases and ensure that any ancillary costs claimed comply with Federal regulations.

We recommend that Southwest Key Programs maintain supporting documentation that shows employees who receive a bonus qualify for the bonus and that bonuses paid comply with Southwest Key’s bonus policy and Federal regulations.

We recommend that Southwest Key Programs revise the bonus policy to establish a maximum percentage when calculating bonuses paid with Federal funds and to ensure that all bonuses are reasonable.

We recommend that Southwest Key Programs ensure that no Federal funding, direct or indirect, is used for future compensation that exceeds the statutorily allowed rate for executive compensation.

We recommend that Southwest Key Programs develop a quality control procedure to ensure that costs claimed are accurate, adequately supported, and benefit the award.

We recommend that Southwest Key Programs maintain documentation to support the FFRs.