Open Recommendations

We recommend that the California Department of Health Care Services implement a system edit for identifying claims with an unreasonable number of counseling service units in 1 day and take appropriate action for the claims identified

We recommend that the California Department of Health Care Services revise the Drug Medi-Cal Billing Manual or provide additional guidance to OTPs regarding the allowable number of counseling service units and work with counties to ensure that their OTP billing manuals do not conflict with State regulations

We recommend that the California Department of Health Care Services take actions to ensure that OTPs comply with Federal and State requirements for providing and claiming reimbursement for OTP services.

We recommend that the California Department of Health Care Services take actions to ensure that OTPs provide the number of counseling services specified in a beneficiary’s treatment plan or document the reasons that counseling services were not provided as specified in the treatment plan.

We recommend that the California Department of Health Care Services take actions to ensure that OTPs maintain documentation supporting that a complete physical evaluation of a patient was performed, including the results of drug use, tuberculosis, and syphilis tests and the identity of the person who performed the physical evaluation.

We recommend that the California Department of Health Care Services take actions to ensure that OTPs have their physicians review and countersign beneficiaries’ treatment plans within the 14-day period as required.

We recommend that the Federal Emergency Management Agency Administratorimmediately issue modified COVID-19 Funeral Assistance operating proceduresthat align with the Individual Assistance Program and Policy Guide provisions9 OIG requested relevant documentation during a November 16, 2021 meeting with FEMA onthis topic.www.oig.dhs.gov 7 OIG-22-36We recommend that the Federal Emergency Management Agency Administrator immediately issue modified COVID-19 Funeral Assistance operating procedures that align with the Individual Assistance Program and Policy Guide provisions on ineligible funeral assistance expenses and ensure all future cost reimbursements by FEMA in connection with the COVID-19 Funeral Assistance Program are necessary expenses associated with funeral services and/or burials.

Oversee a data integrity review at the Yuma Border Patrol station for a sampling of detainees’ custody logs for 1 month, to ensure that theinformation reflected is accurate. If the problem persists, please provide additional training to Yuma station agents on how to document detainees’ activity logs accurately.

Update Handbook PO-502, Mail Transport Equipment, to establish a comprehensive audit policy addressing the audit frequency and threshold for Postal Service facilities and mailers subject to audits and documenting audit results.

Embassy Montevideo should comply with all Department Overseas Motor Vehicle Safety standards for chauffeurs and incidental drivers under chief of mission authority.

Embassy Montevideo should bring its contracting officer’s representative program into compliance with Department standards.

Embassy Montevideo should comply with Department standards with respect to the use of shipping containers for permanent storage space and functional space.

The Under Secretary for Health ensures that the National Practitioner Data Bank facility reporting practices align with federal regulations and Veterans Health Administration policy.

The Under Secretary for Health ensures programmatic oversight of facility State Licensing Board and National Practitioner Data Bank reporting processes.

(U) Rec. A.1.a: The DoD OIG recommended that the Director of the Defense Health Agency, in conjunction with the Secretaries of the Military Departments, establish a working group to address the staffing challenges identified by Military Medical Treatment Facilities during this evaluation. The working group should establish milestones to streamline the hiring process to allow Military Medical Treatment Facilities to more quickly fill civilian staffing positions.

(U) Rec. A.1.b: The DoD OIG recommended that the Director of the Defense Health Agency, in conjunction with the Secretaries of the Military Departments, establish a working group to address the staffing challenges identified by Military Medical Treatment Facilities during this evaluation. The working group should establish milestones to determine if salaries for Military Medical Treatment Facility civilian nurses are commensurate with each facility's local market and if military treatment facilities are able to hire nurses at those salaries. For locations where military treatment facility salaries are not commensurate with the local market, take appropriate actions that will reduce the…

(U) Rec. A.1.c: The DoD OIG recommended that the Director of the Defense Health Agency, in conjunction with the Secretaries of the Military Departments, establish a working group to address the staffing challenges identified by Military Medical Treatment Facilities during this evaluation. The working group should establish milestones to establish a central authority with the knowledge of the Services' requests for individual and large group deployments of medical staff coming out of Military Medical Treatment Facilities and the associated risks to health care delivery.

(U) Rec. A.1.d: The DoD OIG recommended that the Director of the Defense Health Agency, in conjunction with the Secretaries of the Military Departments, establish a working group to address the staffing challenges identified by Military Medical Treatment Facilities during this evaluation. The working group should establish milestones to assess the ability of Military Medical Treatment Facilities to rapidly receive augmentation of medical staff from the Reserve Components.

(U) Rec. A.2.a: The DoD OIG recommended that the Director of the Defense Health Agency, in coordination with the Secretaries of the Military Departments establish the manpower requirements for the coronavirus disease-2019 mission within the Military Medical Treatment Facilities for the staff required to support testing, vaccinations, contact tracing, and acute respiratory clinics.

(U) Rec. A.2.b: The DoD OIG recommended that the Director of the Defense Health Agency, in coordination with the Secretaries of the Military Departments identify the medical personnel requirements within the Military Medical Treatment Facilities, including clinicians, nurses, and support staff, needed for future long-term pandemic response and biological incidents.

(U) Rec. B: The DoD OIG recommended that the Assistant Secretary of Defense (Health Affairs) develop DoD policy for the maximum consecutive hours to be worked, maximum shifts per week, and coverage of duties when absent, for Military Health System staff (at minimum, active duty military and civilian physicians, nurses, respiratory therapists, and lab technicians) working in Military Medical Treatment Facilities to reduce the physical impacts leading to fatigue and burnout, and develop the appropriate waivers of this policy for Military Health System staff.

(U) Rec. C: The DoD OIG recommended that the Assistant Secretary of Defense (Health Affairs) direct a new or existing working group to develop a plan to implement the recommendations in the Military Health System COVID-19 After Action Report and to develop and monitor milestones for each recommendation.

We recommend that the South Carolina Department of Health and Human Services work with the Department of Disabilities and Special Needs to ensure that providers follow the reporting requirements for critical events.

We recommend that the South Carolina Department of Health and Human Services work with the Department of Disabilities and Special Needs to provide training to providers on recognizing and reporting critical incidents according to reporting requirements.

We recommend that the South Carolina Department of Health and Human Services work with the Department of Disabilities and Special Needs to perform analytical procedures, such as data matches, on Medicaid claims data to identify any unreported critical incidents, and investigate as needed.