Open Recommendations

HHS should continue to explore a vehicle to conduct recovery audits that will fit into the larger Medicare Part C program in FY 2021

HHS should continue to follow up with States during the interim period to verify that corrective actions identified after the improper payment error rate measurement review for the Medicaid and CHIP programs are being implemented. NOTE: The current COVID-19 public health emergency may impact the ability of States to analyze and follow up on corrective action plans. Consequently, this will impact the information reported to CMS.

HHS should focus on the root causes of the improper payment percentage and evaluate critical and feasible action steps to assist States with their compliance efforts for new requirements of the Medicaid and CHIP programs

HHS should continue to work with the Office of Management and Budget and other stakeholders to develop and implement an approach to reporting on Temporary Assistance for Needy Families (TANF) improper payments in FY 2021, which will aid in identifying root causes of TANF improper payments and allow HHS to develop and report corrective action plans

Provide guidance identifying programs and/or activities as a part of its internal guidance and in accordance with achieving its mission requirements.

Align programs and/or activities with applicable reporting requirements.

Report programs and/or activities in accordance with applicable Federal criteria.

Provide training to CPSC program managers on how to develop and implement a formal internal controls program in accordance with Standards for Internal Control in the Federal Government, OMB Circular A-123, and CPSC policies and procedures.

Develop a formal internal controls program over operations for CPSC programs.

Establish formal lines of communication between the Office of Financial Management, Planning and Evaluation and CPSC program management for the purpose of assessing and monitoring internal control programs and compliance with FMFIA requirements.

Standardize acquisition and assistance award requirements to include (a) codes of conduct specific to sexual exploitation and abuse for all implementers and (b) requirements for implementers to review and certify that subimplementers establish sexual exploitation and abuse-related internal controls and codes of conduct.

Issue guidance to Agency staff on roles and responsibilities for assessing implementers' internal controls designed to protect beneficiaries from sexual exploitation and abuse when conducting pre-award risk assessments.

We recommend that the New York State Department of Health refund $9,325,338 to the Federal Government

We recommend that the New York State Department of Health identify and recover improper managed care payments made to the same MCO on behalf of beneficiaries with more than one Medicaid ID number prior to and after our audit period, and repay the Federal share of the amounts recovered

We recommend that the New York State Department of Health ensure that improvements made to its processes for determining whether an individual applying for Medicaid has already been assigned a Medicaid ID number are effective by verifying that: - system queries are adequate to identify all individuals with existing Medicaid ID numbers and - local district and Marketplace staff are following guidance on identifying individuals with Medicaid ID numbers and using all available resources to identify and prevent the issuance of more than one Medicaid ID number to the same individual.

We recommend that the Centers for Medicare & Medicaid Services direct the Medicare contractors to educate providers on the billing of direct LDL tests in addition to lipid panels (e.g., by providing guidance about the requirements for separately billing direct LDL tests).

We recommend that Suncoast Hospice refund to the Federal Government the portion of the estimated $47,363,971 for hospice services that did not comply with Medicare requirements and that are within the 4-year claims reopening period.

We recommend that Suncoast Hospice strengthen its policies and procedures to ensure that hospice services comply with Medicare requirements.

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

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

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

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

Develop and implement a process to validate the data between Foreign Assistance Coordination and Tracking System Info and the Development Information Solution system to maximize its value per GAO's Agile Assessment Guide.

develop new procedures or enhance current ones to identify beneficiaries with concurrent eligibility in another State, which could have saved the State agency an estimated $1,100,008 ($665,440 Federal share) in capitation payments for the month of August 2018

ensure that county caseworkers follow procedures to timely review and terminate eligibility for beneficiaries who were identified as concurrently eligible in another State.