Open Recommendations

Determine the allowability of the questioned transactions and recover $2,227,535, if applicable.

We recommended that CMS direct the MACs to based upon the results of this audit, notify the appropriate providers so that the providers can 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 recommended that CMS direct the MACs to educate outpatient providers on how to correctly bill nonphysician outpatient services provided within 3 days before the date of admission, on the date of admission, or during IPPS stays.

We recommended that CMS ensure that all necessary information is included in the CWF edits to accurately identify and prevent incorrect payments for nonphysician outpatient services provided within 3 days before the date of admission, on the date of admission, or during IPPS stay.

We recommended that CMS direct the Medicare contractors to recover the portion of $11.7 million in identified overpayments (for claims within the 4-year reopening period) resulting from the 40,984 incorrectly billed services and instruct the outpatient providers to refund the portion of the $2,785,607 in deductible and coinsurance amounts (for claims within the 4-year reopening period) that may have been incorrectly collected from beneficiaries or from someone on their behalf.

ASPR should clarify to HPP awardees the flexibility available in meeting Cooperative Agreement requirements.

ASPR should continue to work with CMS to help health care entities comply with the CMS emergency preparedness CoPs.

ASPR should clarify HPP guidance that HCCs’ membership should ensure strategic, comprehensive coverage of their communities’ gaps in preparedness and response.

ASPR should identify ways to incentivize core member participation in HCCs.

We recommend that the BLM determine if the CHS has created a step in its financial system to ensure that the agreement is not automatically charged for intern training costs, regardless of their attendance.

OIG recommends that the Global Engagement Center implement to the extent feasible the results of the staffing needs assessment conducted in response to Recommendation 1.

Implement a system that is accessible to both the EPA and the applicants to track the processing of all tribal-New-Source-Review permits and key permit dates, including application received, application completed, draft permit issued, public comment period (if applicable), and final permit issuance.

Establish and implement an oversight process to verify that the regions update the tribal-New-Source-Review permit tracking system on a periodic basis with the correct and required information.

We recommend the FWS develop and implement an action plan to require States that have not reconciled their records of lands purchased with Program funds for more than 5 years to do so by a specific date.

We recommend the FWS establish and implement controls and timelines to ensure real property records are reconciled in a timely manner.

We recommend that the Centers for Medicare & Medicaid Services increase the number of postpayment reviews of IPF claims to provide IPFs with more feedback on their compliance with Medicare requirements.

We recommend that the Centers for Medicare & Medicaid Services reassess the current CMS reimbursement policy for administrative necessary days that meet inpatient coverage requirements because the beneficiary has not met his or her discharge requirements to determine payment accuracy and effects on beneficiaries.

We recommend that the Centers for Medicare & Medicaid Services promulgate regulations to require that each IPF should have a policy compliant with State law to protect and promote the patient’s right to make informed decisions that includes standards for documenting the patient’s ability to make informed decisions.

We recommend that the Centers for Medicare & Medicaid Services research whether the physician certification and recertification requirements are useful in preventing inappropriate payments and: - if they are useful, continue to enforce them but - if they are not useful, take the steps necessary to eliminate or amend those requirements.

We recommend that the Centers for Medicare & Medicaid Services, while the certification requirements remain in place, revise regulations or guidance to IPFs to require that physician certifications and recertifications be in a specific form, format, or language.

We recommend that the Centers for Medicare & Medicaid Services determine whether patient in-hospital fall rates should be added to the IPFQR program and whether CMS should require present-on-admission indicators on claims as an aid to tracking in-hospital falls.

We recommend that Residential Home Health for the estimated $2,068,902 overpayment for claims that are outside of the Medicare reopening period, exercise reasonable diligence in identifying and returning overpayments in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation.

We recommend that Residential Home Health exercise reasonable diligence to identify and return any additional similar 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 Residential Home Health strengthen its procedures to ensure that the homebound statuses of Medicare beneficiaries are verified and continually monitored and the specific factors qualifying beneficiaries as homebound are documented and beneficiaries are receiving only reasonable and necessary skilled services.

We recommend the Regional Administrator, FEMA Region II, provide training and technical assistance to COR3 on: - its roles and responsibilities as the PA grant recipient; - how to provide technical assistance to the subrecipient regarding PA grant requirements; and, - how to provide technical assistance to the subrecipient regarding its ability to use Category Z, Direct Administrative Cost, to support its recovery operation.