Open Recommendations

[Description omitted; DOJ has determined that this recommendation contains information that is limited official use or classified.]

We recommend that Geisinger Health Plan refund to the Federal Government the $566,476 of net overpayments.

We recommend that Geisinger Health Plan 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.

We recommend that Geisinger Health Plan examine 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.

Update and implement procedures to proactively update or replace operating systems before vendor support ends.

We recommend that the Georgia Department of Community Health work with providers to improve their facilities, staffing, and training.

We recommend that the Georgia Department of Community Health improve its oversight and monitoring of providers.

We recommend that the Georgia Department of Community Health ensure that providers correct the 312 instances of provider noncompliance identified in this report.

We recommend that the DOI ensure bureaus finalize their taser policies within a reasonable timeframe to comply with the DOI policy.

We recommend that the DOI establish and implement training on how to use required incident report systems and require all supervisors to attend.

We recommend that the DOI implement and require training for supervisors on how to review and analyze taser activity reports.

Risk Management

Risk Management

Supply Chain Risk Management

Identity Access Management

Identity Access Management

Identity and Access Management

Configuration Management

Configuration Management

We recommend that the Georgia Department of Community Health refund to the Federal Government $644,802 (Federal share) for single-source physicianadministered drug claims that were ineligible for Federal reimbursement.

We recommend that the Georgia Department of Community Health refund to the Federal Government $9,325 (Federal share) for top-20 multiple-source physician-administered drug claims that were ineligible for Federal reimbursement.

We recommend that the Georgia Department of Community Health work with CMS to determine and refund the unallowable portion of $52,837 (Federal share) for other multiple-source physician-administered drug claims that may have been ineligible for Federal reimbursement and consider invoicing drug manufacturers for rebates for those drug claims that CMS determines are allowable;

We recommend that the Under Secretary of Commerce for Standards and Technology and Director of NIST change policy to ensure (1) UPI is strategically reinvested into MEP and (2) if UPI is not reinvested into MEP, withhold federal funds until UPI is used to pay down allowable project expenses.

We recommend that the Under Secretary of Commerce for Standards and Technology and Director of NIST conduct a thorough review of executive compensation for reasonableness as required by Departmental and NIST criteria.

We recommend that the Under Secretary of Commerce for Standards and Technology and Director of NIST establish policy limits on executive compensation for MEP, including restrictions on Center and subrecipient salaries.