Open Recommendations

We recommend that, for items or services for which the Medicare program establishes a quantity limit, CMS use the results of this audit to research and determine the best method(s) (e.g., nationwide system edits, information-sharing between providers, and other mechanisms) to detect and prevent improper payments to providers.

OIG recommends that OST determine the allowability of the questioned transactions and recover $933,026 if applicable.

OIG recommends that OST work with the Federal Highway Administration to determine the allowability of questioned tribal transactions and recover $5,803,740, if applicable.

OIG recommends that OST work with the Federal Transit Administration to determine the allowability of questioned tribal transactions and recover $136,402, if applicable.

Rec. 1.c: The DoD OIG recommended that the Director, Defense Health Agency perform a review of the $1 million in payments that the managed care support contractors paid for health care services provided from FYs 2019 to 2023 that did not meet the Defense Health Agency-established age limits list, and recoup where applicable. As part of the review, assess the managed care support contractors' medical review process when determining whether the managed care support contractors paid for services and items in compliance with the Defense Health Agency-established age limits list.

Rec. 1.d: The DoD OIG recommended that the Director, Defense Health Agency perform a review of the $26.3 million in questioned costs that the managed care support contractors paid for pediatric enteral formula provided from FYs 2019 to 2023 in which the Defense Health Agency-established aged limits list did not meet the pediatric description as defined by the Centers for Medicare and Medicaid Services and age limits identified within product labeling and medical literature. Initiate recoupment of the payments if the Defense Health Agency determines that the managed care support contractors should not have paid for the pediatric enteral formula.

Rec. 1.a: The DoD OIG recommended that the Director, Defense Health Agency, modify the managed care support contracts or TRICARE guidance to explicitly require the TRICARE managed care support contractors to use the Defense Health Agency-established age limits list for all claims.

Rec. 1.b: The DoD OIG recommended that the Director, Defense Health Agency perform a one-time review to ensure that all existing age limits within the Defense Health Agency-established age limits list match age limits established by the American Medical Association and Centers for Medicare and Medicaid Services, where applicable, and revise the age limits accordingly.

Rec. 1.e: The DoD OIG recommended that the Director, Defense Health Agency revise Defense Health Agency policy to require the Defense Health Agency to perform an annual review of high-risk payments in which managed care support contractors paid claims for health care services and items provided in FY 2024 and future years that did not meet the Defense Health Agency-established age limits list requirements.

Rec 1.a: The DoD OIG recommended that the Assistant Secretary of the Army (Manpower and Reserve Affairs), in coordination with the Commanding General of the Army Training and Doctrine Command conduct a review to determine how trainees entered the Assessment of Recruit Motivation and Strength 2.0 pilot program above the allowable initial entry body fat composition standards.

Rec. 1.b: The DoD OIG recommended that the Assistant Secretary of the Army (Manpower and Reserve Affairs), in coordination with the Commanding General of the Army Training and Doctrine Command develop and implement procedures to ensure the applicants entering the Assessment of Recruit Motivation and Strength 2.0 pilot program meet the authorized body fat percentages.

Rec. 2.a: The DoD OIG recommended that the Commanding General of the Army Training and Doctrine Command, in coordination with the Commanding General of the Army Training Center and Fort Jackson, review resourcing deficiencies within the medical resources dedicated to the Assessment of Recruit Motivation and Strength 2.0 pilot program to develop and implement a plan to meet the medical service requirements for the program.

Rec. 2.b: The DoD OIG recommended that the Commanding General of the Army Training and Doctrine Command, in coordination with the Commanding General of the Army Training Center and Fort Jackson, review resourcing deficiencies within the medical resources dedicated to the Assessment of Recruit Motivation and Strength 2.0 pilot program to develop and implement a plan to manage the number of Assessment of Recruit Motivation and Strength 2.0 pilot program trainees based on the availability of medical resources.

Establish requirements for complete and current Division approvals of State Department of Transportation (State DOT) construction quality assurance programs.

Implement controls to ensure that all applicable construction quality assurance program documents used on State DOT and locally-administered National Highway System (NHS) projects are approved by Divisions and referenced in Stewardship and Oversight Agreements as required.

Require Divisions to develop and implement written procedures for conducting appropriate oversight of State DOT construction quality assurance programs and addressing the minimum oversight areas as described in FHWA's 2006 policy on construction quality assurance.

Assess the project materials certifications related to the $24.3 million in questioned costs we identified. Develop an action plan to confirm that materials submitted under these certificates conform to required standards and take appropriate remedial action, if necessary.

Develop and implement guidance for Divisions' review of materials certifications, including verification that certifications conform to required standards, and establish a uniform definition for exceptions that State DOTs should report.

Update the Agency's guidance on construction monitoring to establish minimum requirements for Divisions' oversight on construction inspection.

Assess the risk of construction quality assurance on locally-administered NHS projects whose local agencies are direct recipients of Federal-aid funds and implement actions to mitigate risks.

Update the Agency's construction quality assurance stewardship review process to address all aspects of compliance and Division oversight. The updated process should address the tracking of States' compliance status and Divisions' required oversight activities.

Update the Agency's construction quality assurance assessment process to incorporate a systematic assessment of fraud risks affecting the program.

Develop and implement an Agencywide construction quality assurance fraud risk strategy, with associated guidance and training, that Divisions can use to prevent, detect, and respond to fraud risks.

Update the Agency's webpage on detecting and reporting fraud in consultation with the Office of Inspector General to correct inaccurate and out-of-date information.

Update FHWA construction quality assurance related webpages to correct out-of-date information.