Open Recommendations

Rec. 1.b: The DoD OIG recommended that the Director of the Defense Health Agency update sampling methodology to consider data characteristics and ensure the sampling methodology is appropriate, including a reasonable number of sample items.

To ensure the training process for future Artemis missions is developed with sufficient time for implementation and revision, we also recommended the Director of the Flight Operations Directorate and the Chief of the Astronaut Office:3. At least 18 months prior to the planned Artemis II launch, coordinate with Artemis program offices to complete the development and chartering of the framework of Artemis boards and panels to ensure alignment with future mission training needs for new vehicles and missions, including Orion, next-generation spacesuits, HLS, and Gateway.

CMS should actively monitor the use and effectiveness of States’ corrective action plans and other remedies, with a focus on making the remedies specific and outcome oriented.

CMS should establish guidelines for progressive enforcement actions, including the use of sanctions, when persistent or egregious performance problems emerge.

CMS should engage with senior State officials earlier and more frequently to address State performance problems.

CMS should disseminate results of State performance reviews more widely to ensure that stakeholders become aware of problems.

CMS should revise the State Operations Manual to reflect current CMS practices in overseeing State survey performance.

Develop and implement written policies and procedures (1) for locating homeowners who have unpaid refunds (for both existing and new refunds), (2) to establish a standard timeframe for mailing refund applications to homeowners after they are requested, and (3) to establish requirements for verifying the termination date based on supporting documents provided by homeowners.

Research, develop, and implement policies and procedures to reduce the number of refunds that have remained unclaimed for an extended period, including consideration of a statute of limitations.

Develop and implement written policies and procedures regarding the designation of legal representation for applicants.

We recommend the Associate Director, Service Center Operations Directorate, enhance performance metrics to ensure the programachieves its purpose.

Establish a reasonable timeframe for grantees to resolve DRGR flags or at a minimum, if a flag cannot be resolved within the established timeframe, have the grantee provide a remediating comment explaining why the flag could not be resolved and a proposed timeline for resolution.

We recommend that Healthfirst Health Plan, Inc. refund to the Federal Government the $5,221,901 of estimated net overpayments.

We recommend that Healthfirst Health Plan, Inc. 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 Healthfirst Health Plan, Inc. identify, for the potentially mis-keyed diagnosis codes described in this report, similar instances of noncompliance that occurred during our audit period but were not included in our non-statistical sample and refund any resulting overpayments to the Federal Government.

We recommend that Healthfirst Health Plan, Inc. continue its examination of 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.

Review all existing guidance to ensure that the use of Letters of Credit is not allowed for goods or services that should be procuredwith a Federal Acquisition Regulation contract.

Strengthen oversight of the National Flood Insurance Program cash management process to ensure Write Your Own insuranceproviders’ and NFIP Direct and Bureau and Statistical Agent contractors’ accounts receivable and accounts payable aging reports and bankreconciliations are reviewed.

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We recommended that Noridian Healthcare Solutions, LLC, work with CMS to ensure that its final settlement of contract costs reflects an increase in Medicare pension costs of $620,072 for CYs 2014 through 2016.