Open Recommendations

USAID/North Macedonia's determine the allowability and collect as appropriate, the shortfall amount of $30,516, as detailed in page 11 of BDO's report.

We recommend that the State agency review the revenues reported on the fiscal reports of providers not reviewed in this audit and recover any excess unexpended funds.

We recommend that SAMHSA recover $1,800,212 from the State agency.

We recommend that the State agency develop and implement procedures to ensure that the necessary staff have access to Medicaid revenue data and reconcile the data with the revenue reported on providers’ fiscal reports.

We recommend that SAMHSA provide formal guidance to the State agency on amending the FFR to reflect actual SABG expenditures.

We recommend that SAMHSA provide formal guidance to the State agency on alerting SAMHSA about any unexpended funds.

We recommend that SAMHSA provide formal guidance to the State agency on accounting for SABG expenditures.

Using NIST guidance, test and authorize CDM applications (such as BigFix) that have been placed into operation on DOT's networks without proper security control assessments.

Direct OST to prioritize and resolve COE security weaknesses identified by assessor, and develop POA&Ms that realistically reflect resources and timeframes for completions of these actions.

Direct OST to establish MOUs that delineate the responsibilities for COE common controls with each of the following OAs: FHWA, FMCSA, FRA, FTA, OIG, MARAD, SLSDC, and NHTSA.

Recover the $43,626 in questioned Federal costs and $19,390 in education awards and address any impact to Federal costs of the $33,720 in questioned match costs for American Red Cross of Indiana for grant No. 15ACHIN001.

We recommend the Immigration and Customs Enforcement Director: Implement the use of an electronic system comparable to, or more accurate than, eTD as a source for official statistics, to improve the measures of cooperation with travel document requests.

We recommend that the State agency refund $3,781,709 to the Federal Government for unallowable TCM claims.

We recommend that the State agency strengthen its policies and procedures to ensure that TCM providers maintain documentation to document that case managers are qualified to perform TCM services,TCM providers maintain documentation to support the TCM services provided, it does not pay TCM providers or claim Federal reimbursement for services that are not TCM services, and it correctly reports recoupment of TCM claims from TCM providers on its CMS-64 reports.

CMS should require SNFs to obtain from the hospital or beneficiary, at the time of admission, a copy of the hospital’s written notification to the beneficiary and retain it in the beneficiary’s medical record (if necessary, CMS should seek statutory authority to do so);

CMS should educate hospitals about the importance of explicitly communicating the correct number of inpatient days to beneficiaries and whether the inpatient days qualify subsequent SNF care for Medicare reimbursement so that beneficiaries understand their potential financial liability related to SNF care

CMS should require SNFs to provide written notice to beneficiaries if Medicare is expected to deny payment for the SNF stay when the 3-day rule is not met (if necessary, CMS should seek statutory authority to do so);

CMS should ensure that when SNF claims are being processed for payment, the Common Working File (CWF) qualifying inpatient hospital stay edit for SNF claims is enabled and operating properly to identify SNF claims ineligible for Medicare reimbursement;

CMS should educate SNFs about their responsibility to submit accurate and valid claims for payment that are supported with documentation that clearly shows that the SNF services qualify for reimbursement.

CMS should require hospitals to provide a written notification to beneficiaries whose discharge plans include post-hospital SNF care, clearly stating how many inpatient days of care the hospital provided and whether the 3-day rule for Medicare coverage of SNF stays has been met (if necessary, CMS should seek statutory authority to do so)

Develop and implement a "terminal leave" policy that provides that under no circumstances shall a proposed or final determination on a personnel action, whether based on deficient performance or misconduct, be delayed or not taken so that an employee can accumulate service time, whether by remaining on duty, while on administrative leave, while on leave without pay, or while on annual leave, in order to attain eligibility for benefits, including but not limited to retirement benefits.