Open Recommendations

Direct TSU to strengthen its administrative and management controls and processes over the proper allocation of costs.

Direct TSU to update its administrative and management processes and internal control procedures related to assigning participant support costs within its accounting system.

Direct TSU to update its administrative and management processes and internal control procedures surrounding the Award Cash Management $ervice system.

Direct TSU to strengthen the administrative and management procedures over certifying time and effort reports in a timely manner.

Direct TSU to strengthen the administrative and management procedures to require the inclusion of pertinent information on time and effort reports such as fund codes, award numbers, and work descriptions.

We recommend that the New York State Department of Health refund to the Federal Government or provide documentation of such refund, totaling $97,998,292. Specifically refund to the Federal Government $77,152,491 related to random moments that could not be supported as Medicaid-eligible health services; refund to the Federal Government $1,238,102 for intergovernmental agreement payments that the State agency did not support that it did not double-claim; and refund to the Federal Government or provide documentation of the refund to CMS of $19,607,699 for excess costs claimed on the Form CMS-64 for 1 year.

We recommend that the New York State Department of Health refund $32,267,478 to the Federal Government or provide documentation to CMS to establish that it met an exception to use SY 2013 RMTSs to allocate costs for SY 2012.

We recommend that the New York State Department of Health refund $308,972,87027 to the Federal Government or provide documentation that it can reasonably support, under the circumstances, its allocation of health services costs to Medicaid without using unverifiable IEP ratios.

We recommend that the New York State Department of Health ensure that its contractor (1) collects sufficient information so the State agency can validate the contractor's coding of sampled moments and (2) correctly offsets and supports intergovernmental agreement transactions.

We recommend that the New York State Department of Health revise its certified public expenditures SSHSP to (1) include September days worked in its random moment time study and (2) develop an accurate, supportable method to identify Medicaid costs instead of unverifiable IEP ratios.

We recommend that Palmetto GBA, LLC, discontinue using its internal policies of waiving certain overpayment collections related to lookback years and start collecting all hospice cap overpayments and paying refunds in accordance with CMS requirements.

We recommend that Palmetto GBA, LLC develop processes for communication between the departments directly and indirectly involved in hospice cap oversight.

Develop a policy describing the circumstances, if any, under which telephonic interviews of alleged child abuse victims, including adults who had allegedly been victims of abuse as children, are appropriate.

Train FBI employees on the policies discussed in the first three recommendations and any changes made to them.

Reassess its policies to more precisely describe for FBI employees when they are required to promptly contact and coordinate with applicable state and local law enforcement and social service agencies after receiving allegations of crimes against children that potentially fall under state jurisdiction, even when the allegations also potentially fall within the FBI's jurisdiction.

Reassess its policies to describe the circumstances under which victim services should be offered during Pre-Assessment or Assessment activities, such as when these phases take longer than expected, when a victim is interviewed as part of these phases, or when an initial complaint is transferred between field offices.

Clarify its policies as to what type of file FBI employees should use to retain documentation received during Pre-Assessment activities that continue for more than 5 days.

Develop and implement a process to segregate non-CDL holder convictions from all Commercial Driver's License Information System reports and workbooks utilized to evaluate State's compliance with CDL regulations.

We recommend that Partners In Care, Inc. refund to the Federal Government the portion of the estimated $11,278,891 for hospiceservices that did not comply with Medicare requirements and that are within the 4-yearreopening period.

We recommend that Partners In Care, Inc. based upon the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.

We recommend that Partners In Care, Inc. strengthen its policies and procedures to ensure that hospice services comply with Medicare requirements.

We recommend the Federal Emergency Management Agency Administrator address unresolved implementation issues, publish proposed regulations for notice and comment within 1 year, and issue final regulations within 3 years of issuance of this report for implementation of the Disaster Mitigation Act of 2000, 42 U.S.C. § 5172(b)(2).

We recommend the Federal Emergency Management Agency Administrator review and resolve hazard mitigation challenges, such as: 1. ensuring education and training of states and applicants on mitigationprograms and availability of funding at the state and applicant levels;2. revising criteria and instructions for completing benefit-cost analyses toclarify and streamline the process and assist applicants with meeting therequired benefit-cost threshold;3. streamlining the processes from application submission to approval todecrease applicants’ wait time for mitigation; and4. considering existing flexibilities to adjust the cost share for applicantsexperiencing financial hardships.

Update Agency guidance on practical enforceability to more clearly describe how the technical accuracy of a permit limit should be supported and documented. In updating such guidance, the Office of Air and Radiation should consult and collaborate with the Office of Enforcement and Compliance Assurance, the Office of General Counsel, and the EPA regions.

In consultation with the EPA regions, develop and implement an oversight plan to include: (a) an initial review of a sample of synthetic-minor-source permits in different industries that are issued by state, local, and tribal agencies to assess whether the permits adhere to EPA guidance on practical enforceability, including limits that are technically accurate, have appropriate time periods, and include sufficient monitoring, record-keeping, and reporting requirements; (b) a periodic review of a sample of synthetic- minor-source permits to occur, at a minimum, once every five years; and (c)procedures to resolve any permitting deficiencies identified during the initial and periodic reviews.