Open Recommendations

The Under Secretary for Health evaluates the process for granting authorized access to VA computer systems for health profession trainees and takes steps to ensure access is provided by the start of trainee rotations at VA facilities.

The VA Healthcare System Serving Ohio, Indiana, and Michigan Network Director ensures the corrective actions developed by facility leaders to address surgical intensive care unit patient safety concerns are completed and evaluated for effectiveness.

Resolve the $388,319 in questioned salary costs and direct Columbia to repay or otherwise remove the sustained questioned costs from its NSF awards.

Direct Columbia to provide documentation supporting it has repaid or otherwise credited the $48,706 in questioned unsupported subaward and relocation expenses for which it has agreed to reimburse NSF.

Direct Columbia to provide documentation supporting it has repaid or otherwise credited the $14,161 in questioned unallowable fringe benefit, subaward, and travel expenses for which it has agreed to reimburse NSF.

Direct Columbia to provide documentation supporting it has repaid or otherwise credited the $9,441 in questioned indirect cost expenses for which it has agreed to reimburse NSF.

Direct Columbia to establish and implement policies and procedures or internal controls for ensuring that invoices are processed and paid within the 30-day time limit.

We recommend that USAID/Kenya and East Africa verify that Strathmore University corrects the two instances of material noncompliance identified on pages 36, 38 to 42 of the audit report.

We recommend that USAID/Democratic Republic of the Congo verify that Humana People to People Congo Asbl corrects the two instances of material noncompliance identified on pages 34, 35 to 37 of the audit report.

We recommend that USAID/Ethiopia verify that Mekdim Ethiopia National Association corrects the three instances of material noncompliance detailed on pages 35 to 38 of the audit report.

We recommend that the West Virginia Bureau for Medical Services refund to the Federal Government $2,159,071 (Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement.

We recommend that the West Virginia Bureau for Medical Services refund to the Federal Government $14,514 (Federal share) for claims for top-20 multiple-source physician-administered drugs that were ineligible for Federal reimbursement.

We recommend that the West Virginia Bureau for Medical Services work with CMS to determine the unallowable portion of $488,185 (Federal share) for other claims for multiple-source physician-administered drugs that may have been ineligible for Federal reimbursement, refund that amount, and consider invoicing drug manufacturers for rebates for these drugs if CMS determines that the drug claims are allowable.

We recommend that the West Virginia Bureau for Medical Services strengthen internal controls for non-crossover claims going forward, to better use collected data to invoice manufacturers and collect rebates for all eligible physician-administered drugs.

We recommend that the West Virginia Bureau for Medical Services consider revising its payment methodology going forward regarding payments for crossover claims, thereby allowing collection of manufacturers' rebates for associated physician-administered drugs.

We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to do the following: Recover $11,399 in overpayments made to suppliers for the 15 sample items that did not meet Medicare requirements.

We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to do the following: Perform additional medical reviews of claims for intermittent urinary catheters and sterile catheter kits, which could have saved Medicare an estimated $35,079,833 for our audit period.

We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to do the following: Provide additional education to suppliers on documenting eligibility for intermittent urinary curved-tip catheters and sterile catheter kits and on documenting refills of catheters and sterile catheter kits. For example, CMS could emphasize the following:

-Medical records that list only a diagnosis without adequate documentation of an enrollee's inability to use a straight-tip catheter are insufficient to support medical necessity for use of a curved-tip catheter.

-Notations of urinary tract infections in medical records are insufficient to support that an enrollee is eligible for…

We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to recover $11,399 in overpayments made to suppliers for the 15 sample items that did not meet Medicare requirements.

We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to perform additional medical reviews of claims for intermittent urinary catheters and sterile catheter kits, which could have saved Medicare an estimated $35,079,833 for our audit period.

We recommend that the Centers for Medicare & Medicaid Services instruct DME MACs to provide additional education to suppliers on documenting eligibility for intermittent urinary curved-tip catheters and sterile catheter kits and on documenting refills of catheters and sterile catheter kits.

Embassy Kinshasa, in coordination with the Bureau of Democracy, Human Rights, and Labor and the Bureau of African Affairs, should bring its Leahy vetting practices into compliance with the embassys standard operating procedure and Department guidance.

Embassy Kinshasa should bring the Economic Sections records management program into compliance with Department standards.

Embassy Kinshasa should provide consular applicants with a waiting area that meets Department standards.

Embassy Kinshasa should issue guidance to sections and bureaus implementing foreign assistance advising them on the travel policy and requiring that monitoring plans for proposed programs take into account limitations on travel and staff capacity.