Open Recommendations

We recommend that the State agency ensure that all eligibility requirements are properly verified.

We recommend that the State agency ensure that eligibility caseworkers properly input applicant information.

We recommend that the State agency ensure that CalHEERS and SAWS have the system functionality to: deny or discontinue Medicaid for an ineligible beneficiary after a previous determination has already been made on the basis of the beneficiary’s MAGI, properly process cases for beneficiaries who were formerly in the foster-care youth program, use SSA data to verify whether a beneficiary is entitled to or enrolled in Medicare, properly redetermine eligibility when a beneficiary is no longer a child, and retrieve and use information from the Department of Homeland Security to determine whether a beneficiary has met the 5-year-bar requirement to…

We recommend that the State agency ensure that eligibility determinations are made in accordance with Federal and State requirements for beneficiaries: who do not provide the required information, e.g., citizenship or lawful presence status, whose presumptive eligibility period has ended, and who may not have met the residency requirement.

We recommend that the State agency develop and implement written policies and procedures, as necessary, to ensure that all payments for nonemergency and non-pregnancy-related services are adjusted for beneficiaries who are subject to the 5-year bar.

Rec. A.1.c: The DoD OIG recommended that the Deputy Chief Management Officer, in coordination with the Armed Forces Retirement Home Chief Operating Officer, quantify the impact each major capital project has on the Armed Forces Retirement Home Trust Fund balance and describe the effects on the resident population of the Armed Forces Retirement Home. In addition, the Deputy Chief Management Officer should establish a threshold in which it considers a capital project to be a major capital project and require that the Armed Forces Retirement Home detail how the major capital project risks will be isolated, minimized, monitored, and controlled…

The Commissioner, Small Business/Self-Employed Division, should evaluate whether provisions of the MOU require amendment, revision, or termination and ensure that the duties and responsibilities of the IRS, as outlined in the MOU, are executed as required.

We recommend that the State agency bill for and collect from manufacturers rebates for single-source and top-20 multiple-source physician-administered drugs and refund to the Federal Government the estimated $18,326,775 (Federal share).

We recommend that the State agency strengthen the NDC edit (implemented on October 1, 2012) to ensure that NDCs are captured and valid for all drug utilization data.

We recommend that the State agency ensure that all physician-administered drugs eligible for rebates are processed for rebates.

We recommend that the State agency work with CMS to determine whether the other physician-administered drugs were eligible for rebates and, if so, upon receipt of the rebates, refund up to an estimated $7,307,853 (Federal share) of rebates collected.

In coordination with the Office of Enforcement and Compliance Assurance, develop and implement a methodology to evaluate the impact of the revised Agricultural Worker Protection Standard on pesticide exposure incidents among target populations.

We recommend that WPS notify the 208 providers responsible for the remaining 44,820 nonsampled claims, with potential overpayments estimated at $42.3 million, so that those providers can investigate and return any identified overpayments in accordance with the 60-day rule and track any returned overpayments.

Take action, as appropriate, for the 41 beneficiaries identified by our audit.

Evaluate the results for the 41 beneficiaries in our sample and determine whether it should review the remaining population of 13,514 beneficiaries.

Determine whether it should develop additional controls to ensure it informs widow(er) beneficiaries of their option to delay their application for retirement benefits.

Coordinate with the Army Corps of engineers to enhance existing procedures and related controls to ensure all material procurement of goods and services received prior to period-end are timely and accurately accrued.

We recommend that the Bureau of Fiscal Operations revise and document manual and automated internal controls to ensure prevention of Antideficiency Act violations.

We recommend that the Director of HUD's Newark Office of Public Housing require the Authority to provide documentation to show that the $1,294,062 paid to the Long Branch Housing Authority was for eligible, reasonable, necessary, and allocable costs or reimburse its Operating and Capital Fund programs from non-Federal funds for any amount that it cannot support or that is not considered reasonable.

We recommend that the Director of HUD's Newark Office of Public Housing require the Authority to provide documentation to show that the $326,096 paid for goods and services was reasonable or reimburse its Operating and Capital Fund programs from non-Federal funds for any amount that it cannot support or that is not considered reasonable.

We recommend that the Director of HUD's Newark Office of Public Housing require the Authority to provide documentation to show that it had valid contracts in place before disbursing $125,589 to three vendors or reimburse its Operating and Capital Fund programs from non-Federal funds for any amount that it cannot support.

The Commissioner, Wage and Investment Division, should correct programming to reject EIN applications when an EIN has previously been assigned to the same sole proprietor and to reject applications when IRS data indicate that the sole proprietor is deceased.

The Commissioner, Wage and Investment Division, should develop programming to reject estate applications if the decedent TIN is not that of a deceased individual.