Open Recommendations

IHS should conduct additional outreach to Tribal communities to inform them of patient rights, solicit community concerns, and address barriers to reporting of patient abuse.

IHS should ensure that the new incident reporting system is effective and addresses the risks identified in the current system;

IHS should designate a central owner in IHS headquarters to ensure clear roles and responsibilities for shared ownership in implementing patient protection policies, and managing and responding to abuse reports;

IHS should continue to actively promote an organizational culture of transparency and work to resolve barriers to staff reporting of abuse

We recommend that the Texas Health Presbyterian Hospital Dallas strengthen controls to ensure full compliance with Medicare requirements, specifically: - ensure all IRF beneficiaries meet Medicare criteria for acute inpatient rehabilitation and all required documentation is included in the medical record: - ensure all inpatient beneficiaries meet Medicare criteria for inpatient hospital services; - ensure procedure and diagnosis codes are supported in the medical records and staff are properly trained; and - ensure HCPCS codes are supported in the medical records and staff are properly trained.

This recommendation contains information about IT deficiencies which, if made public, could endanger NARA systems. Please contact the OIG if you need further information.

This recommendation contains information about IT deficiencies which, if made public, could endanger NARA systems. Please contact the OIG if you need further information.

This recommendation contains information about IT deficiencies which, if made public, could endanger NARA systems. Please contact the OIG if you need further information.

This recommendation contains information about IT deficiencies which, if made public, could endanger NARA systems. Please contact the OIG if you need further information.

This recommendation contains information about IT deficiencies which, if made public, could endanger NARA systems. Please contact the OIG if you need further information.

This recommendation contains information about IT deficiencies which, if made public, could endanger NARA systems. Please contact the OIG if you need further information.

This recommendation contains information about IT deficiencies which, if made public, could endanger NARA systems. Please contact the OIG if you need further information.

This recommendation contains information about IT deficiencies which, if made public, could endanger NARA systems. Please contact the OIG if you need further information.

This recommendation contains information about IT deficiencies which, if made public, could endanger NARA systems. Please contact the OIG if you need further information.

CMS should reassess the risks and benefits of allowing chart reviews that are notlinked to service records to be used as sources of diagnoses for risk adjustment.

CMS should conduct audits that validate diagnoses reported on chart reviews in the Medicare Advantage encounter data

Implement proactive fraud detection procedures sooner, such as a data analytics capability, so that the company can stop fraudulent payments earlier.

Ensure that the HR department develops and implements key controls consistent with fraud prevention standards, including the following: a. Implementing cost effective fraud awareness initiatives to enable plan members to better recognize and report potential fraud. b. Gathering information on fraud schemes including investigation results and emerging fraud trends to better target their fraud monitoring efforts.

Evaluate which types of Sensitive Investigative Matters (SIM) require advance notification to a senior Department official, such as the Deputy Attorney General, in addition to the notifications currently required for SIMs, especially for case openings that implicate core First Amendment activity and raise policy considerations or heighten enterprise risk, and establish implementing policies and guidance, as necessary.

Evaluate which types of Sensitive Investigative Matters (SIM) require advance notification to a senior Department official, such as the Deputy Attorney General, in addition to the notifications currently required for SIMs, especially for case openings that implicate core First Amendment activity and raise policy considerations or heighten enterprise risk, and establish implementing policies and guidance, as necessary.

Ensure that appropriate training on DIOG 4 is provided to emphasize the constitutional implications of certain monitoring situations and to ensure that agents account for these concerns, both in the tasking of CHSs and in the way they document interactions with and tasking of CHSs.

We recommend that Pathways for Children, Inc. implement policies and procedures to request prior written approval from ACF before purchasing capital assets.

We recommend that Pathways for Children, Inc. implement policies and procedure to require that LEAs provide documentation to Pathways showing that IEP services were not paid by Federal funds.