Open Recommendations

We recommend that the Regional Administrator, FEMA Region IV, assess the status and adequacy of FDEM's corrective actions with respect to establishing a subrecipient monitoring program and reviewing subrecipient Single Audit reports.

Resolve the $136,024 in questioned conference, travel, and AURA service costs and direct UNC to repay or otherwise remove the sustained questioned costs from its NSF awards.

Direct UNC to provide support verifying that it has repaid or otherwise credited the $39,389 of questioned equipment, internal service center, salary, and other direct costs for which it has agreed to reimburse NSF.

Resolve the $164,313 in questioned subaward costs and direct UNC to repay or otherwise remove the sustained questioned costs from its NSF awards.

Direct UNC to provide support verifying that it has repaid or otherwise credited the $103,250 of questioned unsupported ACM$ cash drawdowns for which it has agreed to reimburse NSF.

Resolve the $26,505 in inappropriately allocated materials and supplies, travel, and equipment costs for which UNC has not agreed to reimburse NSF and direct UNC to repay or otherwise remove the sustained questioned costs from its NSF awards.

Direct UNC to provide support verifying that it has repaid or otherwise credited the $61,496 of questioned materials and supplies, travel, equipment, and other direct costs for which it has agreed to reimburse NSF.

Resolve the $11,542 in meal and lodging per diem expenses for which UNC has not agreed to reimburse NSF and direct UNC to repay or otherwise remove the sustained questioned costs from its NSF awards.

Direct UNC to provide support verifying that it has repaid or otherwise credited the $75,065 in questioned pre-award, PSC, airfare, and other direct cost expenses for which it has agreed to reimburse NSF.

Direct UNC to provide support verifying that it has repaid or otherwise credited the $65,314 of questioned indirect costs for which it has agreed to reimburse NSF.

Resolve the $30,435 in questioned costs related to inappropriately procured equipment and services for which UNC has not agreed to reimburse NSF and direct UNC to repay or otherwise remove the sustained questioned costs from its NSF awards.

Direct UNC to provide support verifying that it has repaid or otherwise credited the $5,143 in server costs for which it has agreed to reimburse NSF.

Direct UNC to provide support to verify that it has repaid or otherwise credited the $17,136 of questioned costs caused by accounting issues for which it has agreed to reimburse NSF.

Direct UNC to provide support to verify that it has repaid or otherwise credited the $9,059 of questioned costs in inappropriately treated GRFP expenses for which it has agreed to reimburse NSF.

To address the 164 incorrectly billed hospital claims in our sample, we recommend that the Centers for Medicare & Medicaid Services: CMS notifies appropriate providers (i.e., those for whom CMS determines this audit constitutes credible information of potential overpayments) so that the providers can exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule, and identify any of those returned overpayments as having been made in accordance with this recommendation.

We recommend that the Centers for Medicare & Medicaid Services: review how hospitals are using diagnosis code E41 for nutritional marasmus and diagnosis code E43 for unspecified severe protein-calorie malnutrition and work with hospitals to ensure that they correctly bill Medicare when using severe malnutrition diagnosis codes.

To address the 164 incorrectly billed hospital claims in our sample, we recommend that the Centers for Medicare & Medicaid Services: collect the portion of the $914,128 for the incorrectly billed hospital claims that are within the reopening period.

Make a determination regarding the allowability of questioned costs identified in this report and recover those costs determined to be unallowable.

Make a determination regarding the allowability of questioned costs identified in this report and recover those costs determined to be unallowable;

We recommend that the Centers for Medicare & Medicaid Services issue guidance, such as an Informational Bulletin, to inform States that performing a data analysis to identify Medicaid claims containing one or more diagnosis codes indicating potential child abuse or neglect could help identify incidents of potential child abuse or neglect and help ensure compliance with the States’ mandatory reporting laws.

We recommend that the Centers for Medicare & Medicaid Services assess the sufficiency of existing Federal requirements to report suspected child abuse and neglect of Medicaid beneficiaries to determine whether it should strengthen those requirements or seek additional authorities to provide oversight over the reporting of suspected child abuse and neglect of Medicaid beneficiaries.

We recommend that the Texas Health and Human Services Commission implement a system to ensure that it can track complaints not closed within 10 days.

We recommend that the Texas Health and Human Services Commission implement procedures to ensure that ensure that procedures are followed to detect unreported deaths.

We recommend that the Texas Health and Human Services Commission implement procedures to ensure that investigations of abuse, neglect, and exploitation are entered in the Health and Human Services Enterprise Administration Reporting and Tracking system database.

We recommend that Sharon Baptist Head Start: refund to the Federal Government the $36,264 in unallowable rent expense charged to its direct Head Start grant during our audit period,