Open Recommendations

We recommend that the Centers for Medicare & Medicaid Services, as part of its ERM program, implement a process to assess all of its programs for national security risks in accordance with OMB Circular No. A-123's requirement to include new or emerging risks in the risk profile.

We recommend the Associate Administrator, FEMA Office of Response and Recovery ensure its direct housing information system provides flexibility implementing alternative direct housing options; provides support to states, territories, and tribal governments administering direct housing assistance; and facilitates data exchange and sharing with non-FEMA information systems.

Reassess the cost estimate for Electronic Health Record Modernization program-related information technology infrastructure and refine as needed to comply with VA’s cost-estimating standards.

Develop procedures for cost-estimating staff that align with VA cost-estimating guidance.

Ensure costs for all information technology infrastructure upgrades funded by the Office of Information and Technology and the Veterans Health Administration or other sources needed to support the Electronic Health Record Modernization program are disclosed in program life-cycle cost estimates presented to Congress.

Formalize agreements with the Office of Information and Technology and the Veterans Health Administration identifying the expected contributions from each entity toward information technology infrastructure upgrades in support of the Electronic Health Record Modernization program.

Establish procedures that identify when life-cycle cost estimates should be updated and ensure those updated estimates are disclosed in the program’s congressionally mandated reports.

We recommend that Puerto Rico Department of Health revise its EOP, including adding or updating procedures, to comply with HPP-PHEP Cooperative Agreement requirements related to: (1) conducting annual public health and medical preparedness exercises or drills that include at-risk populations in all of its planning and activities; (2) identifying resources for at-risk populations; (3) anticipating storage needs for a surge of human remains; (4) implementing and identifying emergency procurement procedures; (5) clearly defining HCC Specialists' responsibilities; (6) obtaining public comment and input on its EOP; (7) utilizing EMAC or other public health mutual aid agreements to support coordinated activities when…

We recommend that the Puerto Rico Department of Health consider working with ASPR to develop an effective method for contacting healthcare volunteers when there are communication challenges.

We recommend that Puerto Rico Department of Health consider coordinating with appropriate organizations to develop guidance on accurate cause-of-death certifications focusing on whether underlying causes of death were disaster-related.

We recommend that the New York State Department of Health (State agency) refund $6,027,566 to the Federal Government.

Based on the results of this audit, we recommend that the Centers for Medicare & Medicaid Services notify appropriate providers (i.e., those for whom CMS determines that this audit constitutes credible information of potential overpayments) so that the providers can 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.

Based on the results of this audit, we recommend that the Centers for Medicare & Medicaid Services implement claims processing controls, including system edits, to prevent and detect overpayments for TCM.

The Bureau of Information Resource Management should review and update the Enterprise IT Help Desk and Desktop Support Master Service Level Agreement to align with the current Bureau of Information Resource Management service catalog.

The Bureau of Information Resource Management should define out-of-scope services in the Enterprise IT Help Desk and Desktop Support Master Service Level Agreement.

The Bureau of Information Resource Management should update the Enterprise IT Help Desk and Desktop Support Master Service Level Agreement to include the methodology for calculating the incident resolution time.

The Bureau of Information Resource Management should update the Enterprise IT Help Desk and Desktop Support Master Service Level Agreement to reflect the current technology modernization policy.

The Bureau of Information Resource Management should review its technology modernization purchasing policies and determine if the Enterprise IT Help Desk and Desktop Support Master Service Level Agreement requires updates to these policies based on its review.

The Bureau of Information Resource Management, in coordination with the Bureau of Administration should, upon completion of the comprehensive cost model study, adjust the Office of Consolidated Customer Support’s desktop service fee, if necessary, and publish a pricing schedule for all customers.

Track implementation of the plan with milestones.

Establish oversight procedures to make certain that part-time physicians submit and validate their subsidiary time sheets and that supervisors promptly certify the time sheets.

Establish oversight procedures for monitoring and validating their medical centers’ compliance with the requirements of the part-time physician on adjustable work schedules program.

We recommend that the Indiana Family and Social Service Administration refund $22,328,438 to the Federal Government.

We recommend that Lake Hospital System refund to the Medicare contractor the portion of the $4,385,974 in estimated overpayments for the audit period for claims that it incorrectly billed that are within the 4-year reopening period.

We recommend that Lake Hospital System based on 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 (This recommendation does not apply to any overpayments that are both within our sampling frame (i.e., the population from which we selected our statistical sample) and refunded based on the extrapolated overpayment amount.  Those overpayments are already covered in the previous recommendation.).