Open Recommendations

Refund to the Federal Government the $7,784,540 of estimated overpayments

Identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before and after our audit period and refund any resulting overpayments to the Federal Government

Continue its examination of its existing compliance procedures to identify areas where improvements can be made to ensure that diagnosis codes that are at high risk for being miscoded comply with Federal requirements (when submitted to CMS for use in CMS's risk adjustment program) and take the necessary steps to enhance those procedures.

Improve controls to ensure employees properly resolve SPAs in a timely manner, such as establishing more timely periodic or follow-up alerts.

CMS should make improvements to the Unified Case Management system.

CMS should implement a plan to help ensure the success of the Major Case Coordination initiative for Medicaid referrals.

CMS should identify the reasons for the unexplained variation in program integrity activities across UPICs.

We recommend the Federal Emergency Management Agency Administrator establish and provide a target completion date to finalize and implement the Equity in Policy Guide and Lens.

We recommend that the BIA resolve the questioned costs of $237,270 by requiring the Three Affiliated Tribes to provide supporting documentation to ensure that the incurred costs are allowable, allocable, and reasonable.

We recommend that the BIA require the Three Affiliated Tribes to establish controls to ensure that it can determine the appropriate funding source for each CARES Act expense.

We recommend that the BIA resolve the questioned costs of $106,280 by creating and adjusting journal entries to reallocate the funds from the U.S. Department of the Interior to the U.S. Department of Health and Human Services.

We recommend that the BIA resolve the questioned costs of $89,623 by creating adjusted journal entries to reallocate the funds from the BIA CARES Act to the appropriate funding source.

We recommend that Dialysis Clinic, Inc refund to the Federal Government the portion of the estimated $14,193,677 in improper payments for claims incorrectly billed to the Medicare program that are within the 4-year reopening period.

We recommend that Dialysis Clinic, Inc. based on the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.

We recommend the Chief Human Capital Officer for DHS’ Management Directorate develop, implement, and communicate departmental policies and procedures for the Unemployment Compensation for Federal Employees program to each component to ensure compliance with Federal requirements.

The Department should ensure that adequate resources are made available and are prioritized to validate the accuracy and completeness of asset inventory counts prior to submission to the Department of Homeland Security (DHS) as part of CIO FISMA Metrics.

Coordinate with the components to develop or revise their plans to fully transition the remaining information systems to enable and enforce PIV, except those that are subject to exclusions that are documented and approved.

FAA should develop and implement procedures to perform periodic reviews of mobile devices to ensure non-compliant mobile devices are upgraded to the current operating system release.

Strengthen processes to ensure privileged account reviews are completed and privileged account activities are logged and periodically reviewed, in accordance with DOT policy.

In coordination with the OA system owners, complete DOT's plans to implement existing solutions where possible and create a plan to address all exceptions where there is not a current solution for encryption of data at rest and in transit.

In coordination with the OA system owners, complete the deployment of DOT's data loss prevention controls to include the utilization or activation of enhanced DLP features available within existing tools and to develop and implement policies and procedures which eliminate or restrict the ability of users to connect mass storage devices to DOT networks and systems.

Enhance current procedures to implement and require the retention of records to track when computer media are sanitized prior to disposal or reuse and implement procedures to validate the remediation of computer media that have failed media sanitization upon return to DOT.

In coordination with the OA system owners, strengthen DOT's oversight of the contingency planning processes to ensure contingency planning documentation is developed, updated, and tested in a timely manner, in accordance with policy.

Create and implement guidance for a QASP or QASP equivalent to use as the basis to monitor performance under medical services contracts that contains: (1) measurable performance standards to ensure desirable contract requirement outcomes including those related to quality and timeliness of care; and (2) standards for maintaining documentation related to the ratings in the QASP.

Create and implement strategies to leverage inmate healthcare utilization data that the OIG recommended to collect in 2016, which would enable the BOP to determine the cost effectiveness of alternative medical services contract structures.