Open Recommendations

We recommend that USAID/Kenya and East Africa verify that Mission for Essential Drugs and Supplies corrects the one material weakness in internal control detailed on page 32 of the audit report.

We recommend that USAID/Kenya and East Africa verify that Mission for Essential Drugs and Supplies corrects the four instances of material noncompliance detailed on pages 34 to 39 of the audit report.

We recommend that USAID/Southern Africa determine the allowability of $112,456 in questioned costs ($104,385 ineligible, $8,071 unsupported) on pages 15 and 21 of the audit report and recover any amount that is unallowable.

We recommend that USAID/Southern Africa verify that Young Heroes corrects the three material weaknesses in internal control detailed on pages 24 to 27 of the audit report.

CMS should Assist MACs in obtaining more complete and timely utilization data with which to make coverage determinations.

CMS should Provide guidance on how MACs should account for enrollees who receive injections in both home and professional settings when performing their comparisons.

We recommend the Assistant Secretary for the Employee Benefits Security Administration pursue legislative changes regarding the authority to impose civil monetary penalties for Mental Health Parity Addiction and Equity Act violations to increase compliance with Part 7 of ERISA, which include the mental health parity provisions.

We recommend the Assistant Secretary for the Employee Benefits Security Administration pursue legislative changes regarding the authority to enforce the group health plan requirements of Part 7 of ERISA against service providers, including insurance issuers and third-party administrators for violations such as designing and applying impermissible non-quantitative treatment limitations.

We recommend the Assistant Secretary for the Employee Benefits Security Administration pursue legislative changes regarding provisions that specify remedies available for violations of Part 7 of ERISA, including the ability to force the re-adjudication of wrongfully denied claims or other remedies to restore losses resulting from Mental Health Parity and Addiction Equity Act violations.

We recommend the Assistant Secretary for the Employee Benefits Security Administration develop processes to utilize enforcement tools available to the agency, including referring health plans to the U.S. Department of the Treasury to levy the excise tax for Mental Health Parity and Addiction Equity Act violations, as appropriate.

We recommend the Assistant Secretary for the Employee Benefits Security Administration develop and issue additional guidance to support the implementation of the 2021 Consolidated Appropriations Act non-quantitative treatment limitation comparative analysis requirements and the September 2024 Mental Health Parity and Addiction Equity Act final rule, such as an updated Mental Health Parity and Addiction Equity Act Self-Compliance Tool or Frequently Asked Questions document(s).

In our February 2024 alert, we recommended that the Director, Field Assistance, take actions to address the issues we identified regarding the hours of operation, incorrect addresses, and current operational status to ensure that taxpayers have the most accurate and up-to-date information available. Additionally, immediate action should be taken to ensure that TAC facilities that are open for extended hours are accessible to taxpayers and that the hours posted at the facility are accurate and observed.

The Chief, Taxpayer Services, should develop processes and procedures to ensure that the hours of operation are accurately posted at all TAC locations and consistent with what is reflected on the IRS website. These processes and procedures should include verification steps to be taken as part of the IRS’s annual filing season readiness confirmation process.

The Chief, Taxpayer Services, should perform a cost-benefit analysis to ensure a business need, including a benefit to the taxpaying public, continues to exist in providing local TAC telephone lines.

The Chief, Taxpayer Services, should develop processes and procedures to ensure the accuracy and consistency of recorded messages while local telephone lines continue to be in place. These processes and procedures should include verification steps to be taken as part of the IRS’s annual filing season readiness confirmation processes.

We recommend that USAID/Southern Africa determine the allowability of $25,847 in ineligible questioned costs on page 20 of the audit report and recover any amount that is unallowable.

We recommend that the Mental Health Center of Florida monitor and evaluate the effectiveness of the QA program updates to ensure that documenting of time spent on psychotherapy services meets Medicare requirements.

We recommend that the Mental Health Center of Florida monitor and evaluate the effectiveness of the QA program updates to ensure that documenting of time spent on psychotherapy services meets Medicare requirements.

We recommend that the Massachusetts Executive Office of Health and Human Services recover from IMDs and CBDCs $21,606,437 in SNCP payments that exceeded the cost of caring for Medicaid and uninsured patients.

We recommend that the Massachusetts Executive Office of Health and Human Services correct its $6,239,386 overstatement of CPEs on the CMS-64, which represents the difference between its CPE estimates and the actual uncompensated care provided to uninsured patients for State-owned hospitals.

We recommend that the Massachusetts Executive Office of Health and Human Services refund to the Federal government the $13,922,912 Federal share of the total $27,845,823 in SNCP expenditures that did not comply with Federal requirements.

We recommend that the Massachusetts Executive Office of Health and Human Services develop and implement policies and procedures that instruct personnel to perform interim and final reconciliations required by the STCs.

We recommend that the Massachusetts Executive Office of Health and Human Services perform reconciliations for the SFYs following our audit period, where the required Medicare cost reports or UFRs are available. In addition, it should refund the Federal share of any oversated CPEs, as well as recover any overpayments to IMDs and CBDCs and refund the Federal share.

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.