Open Recommendations

We recommend that the State agency refund to CMS $32,083 for unallowable G&A costs and related profit fees.

Ensure that the adjudication vendor is able to reproduce on demand all necessary data elements used to adjudicate the claims (e.g., DRG, all procedure codes, and drug information). The universe of claims data should be available to BOP on a national scale in a format that allows for thorough analysis and oversight regardless of institution.

Move immediately to require all CMS contractors to submit electronic claims.

Ensure those claims are properly analyzed and maintained by BOP's adjudication vendor.

Enforce existing contract language that requires the adjudication vendor to perform fraud analytics and report any indicators of fraud to the BOP.

Adequately support or reimburse its NSP3 grant subrecipient $53,760 from non-Federal funds for the disbursements not adequately supported.

(U) Rec. B.2: Recommendation is Classified.

Rec. 1: The DoD OIG recommended that the Assistant Secretary of the Army for Installations, Energy, and Environment issue policy to replace the Army Interim Guidance and direct the Commander of the U.S. Army Corps of Engineers to update Engineering Pamphlet 75-1-3 to comply with Army Regulation 25-30.

Rec. B.1.f: The DoD OIG recommended that the Secretary of the Army take prompt action to direct the U.S. Army Provost Marshal General to revise Army Regulation 190-45 to align with the fingerprint card and final disposition report submission requirements in DoD Instruction 5505.11.

Rec. D.1.b: The DoD OIG recommended that the Secretary of the Navy immediately and comprehensively review all Navy Security Forces criminal investigative databases and files to ensure that all fingerprint cards and final disposition reports for anyone investigated for, or convicted of, qualifying offenses before 1998 have been reported to the Federal Bureau of Investigation Criminal Justice Information Service in compliance with DoD and Federal Bureau of Investigation requirements.

Rec. D.1.c: The DoD OIG recommended that the Secretary of the Navy take prompt action to ensure that Navy Security Forces command, supervisory, and management oversight controls verify compliance with fingerprint card and final disposition report submission requirements and ensure that such compliance is included as a special interest item in future Inspector General inspections and is actually conducted.

Rec. D.1.e: The DoD OIG recommended that the Secretary of the Navy take prompt action to ensure that other required investigative and criminal history information, such as criminal incident data and Deoxyribonucleic Acid (DNA) samples, has been submitted for inclusion in Federal Bureau of Investigation databases.

Rec. F.1.b: The DoD OIG recommended that the Secretary of the Air Force immediately and comprehensively review all Air Force Security Forces criminal investigative databases and files to ensure that all fingerprint cards and final disposition reports for anyone investigated for, or convicted of, qualifying offenses before 1998 have been reported to the Federal Bureau of Investigation Criminal Justice Information Services in compliance with DoD and Federal Bureau of Investigation requirements.

Rec. G.1.b: The DoD OIG recommended that the Secretary of the Navy and Commandant of the Marine Corps immediately and comprehensively review all Marine Corps criminal investigative databases and files to ensure that all fingerprint cards and final disposition reports for anyone investigated for, or convicted of, qualifying offenses before 1998 have been reported to the Federal Bureau of Investigation Criminal Justice Information Services in compliance with DoD and Federal Bureau Investigation requirements.

Rec. G.1.e: The DoD OIG recommended that the Secretary of the Navy and Commandant of the Marine Corps take prompt action to ensure that other required investigative and criminal history information, such as criminal incident data and Deoxyribonucleic Acid (DNA) samples, has been submitted for inclusion in Federal Bureau of Investigation databases.

We recommend that the State agency strengthen its controls and oversight activities to ensure that providers maintain required attendance documentation to support the childcare payment amounts that they claim for reimbursement by the State agency.

We recommend that the State agency develop policies and procedures to ensure that it obtains attendance records from providers that are no longer in business.

We recommend that the State agency refund to the Federal Government the estimated $19,076,167 Federal CCDF share of the Child Care Subsidy Program claims paid during SFYs 2014 and 2015.

We recommend the State agency refund $300,452,930 in Federal Medicaid reimbursement claimed based on payment rates that incorporated unallowable costs. This disallowance is based on $220,314,119 calculated by removing allowable costs and RMS study based on correct activity moments plus $80,138,811 which was claimed based on a pending amendments to its State plan. The $220,314,119 includes the effect of including unallowable costs in the rate pool as follows: -Unpaid Pension Costs-$435,287,077 -Unallowable disabilities teacher-consultant salaries $61,528,162 -Special education or non health related services $75,379,253 The rates were recalculated using corrected random moment timestudy activity codes that were changed by the…

We recommend that the State agency work with CMS to determine the allowable amount of the remaining $306,233,377 set-aside because the rates included unallowable costs that could not be quantified. Specifically, the payment rates incorporated non-Medicaid related costs lumped together into activity code with Medicaid related costs. In addition, the sample moments used were not supported

We recommend that the State agency revise its payment rates to comply with Federal requirements.