Open Recommendations

We also recommend that the Centers for Medicare & Medicaid Services work with the DME MACs to do the following, which could have saved Medicare an estimated $7,948,182 during our audit period; Implement a system edit that applies to all PMD repairs and identifies PMD repairs for review of supplier documentation to help ensure that PMD repairs are adequately documented and that the PMD repair charges are reasonable and necessary.

We also recommend that the Centers for Medicare & Medicaid Services work with the DME MACs to do the following, which could have saved Medicare an estimated $7,948,182 during our audit period; Implement a system edit to determine whether PMD repair charges exceed the estimated cost to replace the PMDs being repaired.

We recommend that the Centers for Medicare & Medicaid Services establish Medicare requirements that: (1) include the documentation standards established by guidance for PMD repairs; (2) specify that accumulated costs of repairs made to power wheelchairs during their 5 year RUL must not exceed a certain threshold; and (3) specify that suppliers must provide warranties for repairs made to PMDs, which could have saved Medicare an estimated $3,739,346 during our audit period.

The FBI should clarify its policies regarding the approved methods for transmitting child sexual abuse material (CSAM) and other contraband to prosecutors and other government employees with a need to view the material in their official capacity.

Establish clearly defined and detailed roles, responsibilities, and processes for all SBA offices and officials responsible for managing and handling potentially fraudulent PPP loans to reduce the risk of ineligible applicants receiving PPP forgiveness and the risk of fraud and financial loss in the PPP and when implementing similar future programs.

Provide lenders formal guidance to effectively and consistently handle potentially fraudulent PPP loans and ensure lenders have sufficient guidance when implementing similar future programs.

Improve Agency systems to automate benefit computations and reduce the need for manual processing.

Perform a thorough review of OIG-sampled CARES invoices with questionable costs, and request additional contractor documentation necessary to determine accuracy of CARES hours, rates, and contractor status. If any charges are not allowed, recover as appropriate.

Perform a risk assessment of all CARES invoices and process to determine, at a minimum, the nature and extent of testing required to sufficiently identify unsupported payments.

Develop a plan to fill and retain the allocated number of Office of Human Capital and Talent Management staff needed to fulfill its duties in the hiring and onboarding process.

Develop and disseminate policies for the revised civil service recruitment and hiring process and standard operating procedures for the modified Foreign Service staff hiring and onboarding processes.

Create a USAID-specific definition of skill gaps to address both competency and staffing skill gaps across its hiring mechanisms.

Finalize strategic workforce planning guidance, to include USAID's updated Strategic Workforce Plan, workforce planning Automated Directives System chapter, and materials to assist Agency operating units in identifying and addressing skill gaps.

Conduct an analysis to determine whether personnel tools-e.g., Talent Analytics, LaunchPad, the Workforce Planning Model, or the Competency Exploration for Development and Readiness-can be utilized to track skill gaps at both an Agency and operating unit level and implement changes as appropriate based on this analysis.

We recommend that Peoples Health Network refund to the Federal Government the $3,312,219 in estimated overpayments.

We recommend that Peoples Health Network identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before or after our audit period and refund any resulting overpayments to the Federal Government.

We recommend that Peoples Health Network enhance 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.

We recommend that Vanderbilt University Medical Center improve procedures and provide education to staff to ensure that claims billed to Medicare are accurate

We recommend that Vanderbilt University Medical Center implement changes to its billing system to ensure that claims billed to Medicare are accurate.

The Bureau of Administration should direct its Contracting Officer for Foreign Service Selection Board public contracts to comply with all FAR requirements, including requirements on notices, justifications, and determination of pricing.

Embassy Budapest should comply with Department standards for grant file documentation.

Embassy Budapest should enter motor vehicle operational costs into the Fleet Management Information System and verify the integrity of data entered into the system in accordance with Department standards.

Embassy Budapest should administer and procure facility management expendable supplies in accordance with Department standards.

Embassy Athens should comply with Department standards for consular crisis preparedness.

Embassy Athens should require that safety certifications for all mission properties are conducted and documented in the Post Occupational Health and Safety Officer Certification Application and that any identified safety issues be corrected prior to occupancy, in accordance with Department standards.