Open Recommendations

We recommend that CHI St. Vincent Infirmary amend the 33 claims (10 incorrectly amended and 23 not amended) to identify and return any improper outlier payments that are within the 4-year claims reopening period

We recommend that CHI St. Vincent Infirmary exercise reasonable diligence to identify and return any additional similar overpayments (including overpayments received during our audit period for the remaining $1,072,249 in outlier payments that we did not review and overpayments outside of our audit period), in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation.

We recommend that CHI St. Vincent Infirmary return the $362,999 in improper outlier payments for the 70 claims that have been amended correctly.

We recommend that CHI St. Vincent Infirmary improve procedures and provide education to ensure claims billed to Medicare are accurate.

(U) Rec. 1.b: The DoD OIG recommended that the Secretary of the Navy take prompt action to require the Navy Security Forces to establish management oversight procedures to verify fingerprints and final disposition reports were submitted to the Federal Bureau of Investigation Criminal Justice Information Services Division.

(U) Rec. 3.b: The DoD OIG recommended that the Secretary of Navy take prompt action to establish policy, processes, training, and management oversight procedures for Navy Security Forces personnel to collect and submit Deoxyribonucleic Acid samples to the U.S. Army Criminal Investigation Laboratory for entry into the Federal Bureau of Investigation Combined Deoxyribonucleic Acid Index System as required by DoD Instruction 5505.14.

(U) Rec. 8: The DoD OIG recommended that the Secretary of the Navy revise Secretary of the Navy Instruction 5800.14A to require the DD Form 2791 be provided to the Naval Criminal Investigative Service and the U.S. Marshals Service National Sex Offender Targeting Center as required by DoD Instruction 5525.20.

We recommend that the New York State Department of Health refund $11,257,368 to the Federal Government

We recommend that the New York State Department of Health identify and recover improper managed care payments made to different MCOs on behalf of beneficiaries with multiple Medicaid ID numbers prior to and after our audit period, and repay the Federal share of the amounts recovered

We recommend that the New York State Department of Health strengthen its procedures for determining whether an individual applying for Medicaid has already been assigned a Medicaid ID number by ensuring that: - its system queries identify all individuals with existing Medicaid ID numbers and - local district and Marketplace staff follow guidance on identifying individuals with Medicaid ID numbers and use all available resources to identify and prevent the issuance of multiple Medicaid ID numbers to the same individual.

We recommend that the New York Department of Health refund to the Federal Government $146,672 (Federal share) for claims for top-20 multiple-source physician-administered drugs that were ineligible for Federal reimbursement.

We recommended that the New York Department of Health work with CMS to determine the unallowable portion of $2,340,390 (Federal share) for other claims for covered outpatient physician-administered drugs that were submitted without NDCs and that may have been ineligible for Federal reimbursement and refund that amount, and whether the remaining $714,777 (Federal share) of other physician-administered drug claims could have been invoiced to the manufacturers to receive rebates and, if so, upon receipt of the rebates, refund the Federal share of the manufacturers’ rebates for those claims.

We recommend that the New York Department of Health refund to the Federal Government $3,197,404 (Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement

We recommended that the New York Department of Health work with CMS to determine and refund the unallowable portion of Federal reimbursement for physician-administered drugs that were not invoiced for rebates after December 31, 2017.

We recommended that the New York Department of Health strengthen its internal controls to ensure that all physician-administered drugs eligible for rebates are invoiced.

Rec. 1.a: The DoD OIG recommended that the DoD Office of Small Business Programs Director conduct a review, in coordination with the Military Departments and Defense agencies, of all 17 contractors that received DoD Service-Disabled Veteran-Owned Small Business set-aside or sole-source contracts but were denied Service-Disabled Veteran-Owned Small Business status by the Department of Veterans Affairs Center for Verification and Evaluation to determine if they meet the requirements for Service-Disabled Veteran-Owned Small Business status. Based on the review, the Director should take action, as appropriate, against any contractors found to have misrepresented their Service-Disabled Veteran-Owned Small Business status to the…

Rec. 1.b: The DoD OIG recommended that the DoD Office of Small Business Programs Director conduct a review, in coordination with the Military Departments and Defense agencies, of all 16 contractors in our sample that received DoD Service-Disabled Veteran-Owned Small Business contracts that we determined to be ineligible Service-Disabled Veteran-Owned Small Businesses to determine if they meet the eligibility requirements. Based on the review, the Director should take action, as appropriate, against any contractors found to have misrepresented their Service-Disabled Veteran-Owned Small Business status to the DoD to obtain set-aside and sole-source contracts by coordinating with the applicable contracting officer…

Rec. 1.f: The DoD OIG recommended that the DoD Office of Small Business Programs Director implement procedures, in coordination with Defense Pricing and Contracting, requiring contracting personnel to track and monitor the amounts Service-Disabled Veteran-Owned Small Businesses spend on subcontractors that are not Service-Disabled Veteran-Owned Small Businesses throughout contract performance to ensure that contractors do not exceed the required limitations, as defined by the Code of Federal Regulations.

We recommend the Acting Director, U.S. Immigration and Customs Enforcement, conduct an independent workforce analysis to determine whether centralizing research of aliens and issuing detainers at the Pacific Enforcement Response Center would be more efficient than performing these tasks there as well as at local research centers.

We recommend the Acting Director, U.S. Immigration and Customs Enforcement evaluate how to consistently track lawful permanent residents with pending convictions.

We recommend that the Michigan Department of Health and Human Services refund $27,545,800 to the Federal Government

We recommend that the Michigan Department of Health and Human Services identify capitation payments made on behalf of deceased beneficiaries before and after our audit period and repay the Federal share of amounts recovered

We recommend that the Michigan Department of Health and Human Services identify and recover unallowable payments made to managed care entities during our audit period on behalf of deceased beneficiaries, which we estimate to be at least $39,873,514

1. The Access Approval Process was not followed for the Century Link Data Center (IT-19-01)

3. Control Weakness over Separated Users and Removal of Inactive Users for Greater than 60 Days (IT-19-03)