Open Recommendations

We recommended that CMS use data analytics to identify hospitals that disproportionately use condition code 42 when the diagnosis codes on the inpatient claim and the respective home health claim appear related.

We recommended that CMS direct its Medicare contractors to analyze the remaining inpatient claims in our sample frame with a condition code 42, determine which claims were overpaid, and recover the portion of the estimated $40,610,333 in potential overpayments that are within the 4-year reopening period along with similarly coded inpatient claims paid after our audit period.

We recommended that CMS consider reducing the need for clinical judgment when processing claims under the post-acute-care transfer policy by taking the necessary actions, including seeking legislative authority if necessary, to deem any home health service within 3 days of discharge to be “related” (which would have saved an estimated $46.6 million during our 2-year audit period).

We recommended that CMS create CWF edits to prevent the use of condition code 43 from allowing the hospital to receive the full MS-DRG payment when the beneficiary receives home health services within 3 days of discharge.

We recommended that CMS correct its CWF edits to ensure that the edits use the home health services on each line within a home health claim rather than only the first line, which will allow the edits to capture home health claims that overlap a hospital stay.

Determine the allowability of the questioned transactions and recover $3,440,165, if applicable.

(U) Rec. 2.a: The DoD OIG recommended that the Commander of the Air Force Material Command schedule threat-level electromagnetic pulse protection tests for the KC-135 Block 45 and implement protection efforts.

(U) Rec. 3.a: The DoD OIG recommended that the Commander of Air Mobility Command, in conjunction with the Chief of the Air Force Reserve and the Director of the National Guard Bureau develop plans to ensure that Air Refueling Wing facilities meet Air Mobility Command Instruction 13-520 and Air Force Manual 32-1084 requirements. (ARFC)

(U) Rec. 3.a: The DoD OIG recommended that the Commander of Air Mobility Command, in conjunction with the Chief of the Air Force Reserve and the Director of the National Guard Bureau develop plans to ensure that Air Refueling Wing facilities meet Air Mobility Command Instruction 13-520 and Air Force Manual 32-1084 requirements. (NGB)

(U) Rec. 4: The DoD OIG recommended that the Deputy Chief of Staff of the Air Force for Manpower, Personnel, and Services, in conjunction with the Chief of the Air Force Reserve and the Director of the National Guard Bureau, determine the anticipated future manning levels for aircrew, security forces, and maintenance crews, and develop recruiting and retention efforts to ensure that the U.S. Strategic Command nuclear mission can be performed. (AF/A1)

(U) Rec. 4: The DoD OIG recommended that the Deputy Chief of Staff of the Air Force for Manpower, Personnel, and Services, in conjunction with the Chief of the Air Force Reserve and the Director of the National Guard Bureau, determine the anticipated future manning levels for aircrew, security forces, and maintenance crews, and develop recruiting and retention efforts to ensure that the U.S. Strategic Command nuclear mission can be performed.

We recommend that the FWS work with the Division to reconcile their respective records of lands purchased with Program funds and resolve any identified acreage and cost differences.

We recommend that the FWS require the Commission to implement a financial management system with sufficient internal controls to provide for a reconciliation of all grant claims to actual expenditures recorded in the Commonwealth's System Analysis and Program Development (SAP) accounting system.

Assist the State of Arkansas in developing and submitting a state plan to implement the 2016 municipal solid waste landfill Emission Guidelines. If Arkansas does not submit a state plan, implement the federal plan for the 2016 municipal solid waste landfill Emission Guidelines once the federal plan is effective.

Develop and implement a process for the periodic review of municipal solid waste landfill design capacity information and Title V permit lists to identify municipal solid waste landfills with design capacities over the applicable threshold that have not applied for a Title V permit.

We recommended that the State agency consider having Complaint Intake be the initial recipient of all incident reports from nursing facilities to assist in conducting more effective and timely investigations of all aspects of an allegation within incident reports.

We recommend that the Deputy Commissioner of CBP develop and implement policies to ensure CBP's covert testing groups: a. develop risk-based annual covert test plans and identify systemic tests; b. distribute test results throughout the organization; c. make recommendations; and d. implement and track corrective actions.

We recommend that the Assistant Commissioner of Office of Intelligence and Border Patrol's Chief of Law Enforcement Operations Directorate direct covert testing entities to develop and implement both performance measures and standard operating procedures including: a. processes for determining data to be included in test reports, b. data quality monitoring, and c. supervisory review.

We recommend that the Assistant Commissioner of the Office of Intelligence direct all Operational Field Testing Division staff to review all prior and future classified reports to ensure they are properly marked to protect national security information.

Identify and recover capitation payments made on behalf of deceased beneficiaries before and after our audit period, and repay the Federal share of amounts recovered

Create system edits to help identify overpayments and failures in the automated interfaces between the eligibility, payment, and death data

Use additional sources of date of death consistently to help reduce unallowable payments

Refund $13,696,760 Federal share to the Federal Government

We recommend FEMA develop guidance, including the appropriate milestones in the grant lifecycle, for assessing costs under a T&M contract for reasonableness and eligibility.

We recommend that the New Jersey Department of Human Services continue to work with ACF to reach substantial compliance with criminal background check requirements.