Open Recommendations

We recommend that the FWS work with the Department to resolve the questioned costs related to unsupported leave payouts totaling $3,167.

We recommend that the FWS require the Department to establish policies that follow Federal regulations to ensure leave payouts are allocated based on activity charged to specific grants.

Review the OIG identified potential duplicate disbursements for eligibility and take action to recover any improper payments as applicable

Provide the support staff and equipment necessary at the JFK IMF to adequately inspect mail in a timely manner.

Implement the necessary controls to secure mail in CBP’s possession at the JFK IMF.

[Description omitted; DOJ has determined that this recommendation contains information that is limited official use or classified.]

Review and update, as necessary, all applicable policies to reflect the changes to the statute of limitations created by the Disaster Recovery Reform Act of 2018 for Section 705(a) of the Robert T. Stafford Disaster Relief and Emergency Assistance Act.

Revise FEMA’s process to routinely review all internal policies and procedures when Federal laws and regulations affecting FEMA change to ensure internal policies and procedures remain compliant and required changes are timely.

CMS should ensure the accuracy of non-nurse staffing data used on Care Compare.

1. We recommend that the Florida Agency for Health Care Administration, Division of Health Quality Assurance work with CMS to provide clear guidance to nursing facilities regarding what constitutes a reportable incident.

We recommend that the Florida Agency for Health Care Administration, Division of Health Quality Assurance establish procedures that include documenting assessment start and end dates and priority level assignments.

We recommend that the Florida Agency for Health Care Administration, Division of Health Quality Assurance establish and implement written policies and procedures for incident report processing.

We recommend that the Florida Agency for Health Care Administration, Division of Health Quality Assurance evaluate its staffing levels to determine whether staffing is adequate.

We recommend that the Florida Agency for Health Care Administration, Division of Health Quality Assurance improve the intake process by: (a) assessing all Federal 24-Hour Reports to identify whether potential noncompliance with quality of care standards caused the incidents and whether the incident occurred after the last standard survey; (b) assessing the severity and urgency of harm to the resident(s) that may have been caused by abuse, neglect, or nursing facility noncompliance with CoPs to assign a priority level; and (c) using ACTS to create an incident record with start and end dates for all Federal 24-Hour Report assessments and…

6. We recommend that the Florida Agency for Health Care Administration, Division of Health Quality Assurance establish and implement written policies and procedures for managing incident report late filings and consider immediately initiating onsite surveys of nursing facilities that file Federal 24-Hour Reports late.

7. We recommend that the Florida Agency for Health Care Administration, Division of Health Quality Assurance establish and implement written policies and procedures for managing APS complaint notifications and conducting assessments of APS complaints to identify and survey more facilities where resident harm may have been caused by nursing facility noncompliance.

Identify minimum training (baseline) requirements and follow through by providing, tracking, and documenting this training for project reviewers, including Program Delivery Managers, Document Validation Specialists, and Quality Assurance Specialists, before they perform their duties.

Strengthen the project review process by evaluating FEMA’s internal controls and making improvements that, at a minimum, ensure:(a) projects return to the prior review queue if the projects do not complywith Federal procurement requirements or FEMA guidelines,including when insufficient documentation is provided;(b) roles and responsibilities for procurement reviews and qualityassurance are clearly defined;(c) project review policies are followed, such as the use of DeterminationMemos and Quality Assurance Checklists, as appropriate; and(d) controls are tracked and an auditable file is created in FEMA systems

Utilize the most recent threat assessment to enhance biological agent detection capabilities to respond to the most up-to-date threats.

We recommend that the Centers for Medicare & Medicaid Services work with Treasury and QHP issuers to recover the $43,455 in improper APTCs identified in our sample, or take other remedial action.

We recommend that the Centers for Medicare & Medicaid Services work with Treasury and QHP issuers to recover the remaining improper APTCs, which we estimate to be $950 million, or take other remedial action for policies for which the payments were not allowable.

We recommend that the Centers for Medicare & Medicaid Services develop a process for qualified health plan issuers to provide (a) information related to individuals’ premium payments paid during the benefit year, and (b) enrollees’ policy termination information so that enrollment data provided to the Internal Revenue Service is accurate.

ACF should conduct oversight activities to identify States that may not appoint a GAL to every child victim who undergoes a judicial proceeding, seeking statutory authority as necessary.

ACF should proactively provide technical assistance to States that face challenges in appointing a GAL for every child victim.

ACF should proactively identify and address obstacles that States face in reporting complete and accurate GAL data.