Open Recommendations

Disallow and, if already used, recover education awards made to members who did not serve the minimum required service hours.

We recommend the Secretary of the Department of Homeland Security: Develop and implement a method to track the use of settlement agreements throughout the Department and its components.

We recommend that the Director of the Peace Corps provide country directors with additional support to resolve allegations of drug involvement under manual section 204, 3.5.1 and specifically consider the efficacy of reasonable suspicion drug testing as a means of doing so.

We recommend that the Office of General Counsel review the evidentiary standard required to administratively separate a Volunteer suspected of involvement with drugs to determine whether the standard, and its application, is consistent with promoting the integrity of the program and continues to serve the policy interest of the Peace Corps.

We recommend that CMS work with Treasury and QHP issuers to resolve the potentially improper financial assistance payments, which we estimate to be $504,889,518, for policies for which there was no documentation provided to verify enrollees had paid their premiums

We recommend that CMS work with Treasury and QHP issuers to collect improper financial assistance payments, which we estimate to be $434,398,168, for policies for which the payments were not authorized in accordance with Federal requirements

We recommend CMS clarify guidance for QHP issuers on Federal requirements for terminating an enrollee’s coverage when the enrollee fails to pay his or her monthly premium.

CMS should ensure that valid national drug codes are reported for drugs.

We recommend that the Social Security Administration, as part of its Debt Management modernization initiative, establish controls in the new Debt Management Product that ensure technicians can only use the administrative tolerance waiver for overpayments allowable under the provision.

We recommend that the FEMA Chief Component Human Capital Officer: Adhere to the responsibilities defined in FEMA's Premium Pay Policy and/or update the policy as needed to enact workable steps to enforce the annual premium pay cap.

CMS should increase oversight of general inpatient care claims and focus particularly on general inpatient care provided in SNFs, given the higher rate at which these stays were inappropriate;

CMS should develop and execute a strategy to work directly with hospices to ensure that they are providing drugs covered under the hospice benefit as necessary and that the cost of drugs covered under the benefit are not inappropriately shifted to Part D;

CMS should include on Hospice Compare deficiency data from surveys, including information about complaints filed and resulting deficiencies;

CMS should take appropriate actions to follow up with hospices that engage in practices or have characteristics that raise concerns;

CMS should ensure that a physician is involved in the decisions to start and continue general inpatient care;

CMS should analyze claims data to identify hospices that engage in practices or have characteristics that raise concerns;

CMS should implement a comprehensive prepayment review strategy to address lengthy general inpatient care stays so that beneficiaries do not have to endure unnecessarily long periods of time in which their pain and symptoms are not controlled;

CMS should seek statutory authority to establish additional remedies for hospices with poor performance

CMS should develop other claims-based information and include it on Hospice Compare

CMS should adjust payments based on these analyses, if appropriate, to ensure that the payment system is aligned with beneficiary needs and quality of care

CMS should assess the current payment system to determine what changes may be needed to tie payments to beneficiaries’ care needs and quality of care to ensure that services rendered adequately serve beneficiaries’ needs;

CMS should modify the payments for hospice care in nursing facilities.

CMS should work with its partners, such as hospitals and caregiver groups, to make available consumer-friendly information explaining the hospice benefit to beneficiaries and their families and caregivers;

CMS should analyze claims data to inform the survey process.