Open Recommendations

Bureau for Asia coordinate with USAID/Regional Development Mission for Asia, USAID/Central Asia Regional, and USAID/Philippines, Pacific Islands, and Mongolia to develop and implement an action plan to bring each mission's monitoring and enforcement practices for acquisition and assistance awards into compliance with trafficking in persons regulations, policies, and procedures.

We recommend that the Puerto Rico Department of Health develop written policies and procedures to use sources other than the Puerto Rico Demographic Registry to identify deceased enrollees.

We recommend that the Puerto Rico Department of Health identify capitation payments made after the audit period on behalf of deceased enrollees and refund to the Federal Government the Federal share of any unallowable payments.

We recommend that the Puerto Rico Department of Health refund $6,979,822 to the Federal Government.

We recommend that the Puerto Rico Department of Health establish a process with ASES to ensure ASES ceases making payments to MCOs on behalf of enrollees after their deaths are recorded in DOH's eligibility system and recoups unallowable payments made on behalf of deceased enrollees.

We recommend that the Puerto Rico Department of Health develop written policies and procedures to ensure that DOH staff periodically update, at least monthly, DOH's eligibility system with data on deaths recorded in the Puerto Rico Demographic Registry.

We recommend that the Puerto Rico Department of Health identify capitation payments made on behalf of enrollees with a date of death in the DMF before the month covered by the capitation payments, estimated as $885,123 in Federal Medicaid funds, and refund to the Federal Government the Federal share of any unallowable payment.

We recommend that the Substance Abuse and Mental Health Services Administration improve its policies and procedures for awarding CCBHC-E grants to ensure that clinics comply with Federal requirements by establishing required time frames to verify that clinics met certification eligibility requirements, and processes to verify whether clinics entered into agreements with DCOs to provide certain services.

We recommend that the Substance Abuse and Mental Health Services Administration improve its policies and procedures for monitoring CCBHC-E grants to ensure that clinics comply with Federal requirements by establishing processes to verify that clinics filled key personnel positions, ensured key personnel met level-of-effort requirements, timely submitted FFRs, and properly reported cash on hand.

We recommend that the Puerto Rico Department of Health establish policies and procedures with the Puerto Rico Health Insurance Administration (referred to in Spanish with acronym ASES) to ensure ASES recovers unallowable payments made on behalf of enrollees assigned more than one identification number.

We recommend that the Puerto Rico Department of Health refund $516,762 to the Federal Government.

We recommend that the Puerto Rico Department of Health strengthen its process for ensuring that no person is issued more than one identification number.

We recommend that ACF develop mitigating controls and strategies to lower the high and moderate risks we identified.

We recommend that the Centers for Disease Control and Prevention develop an action plan to enforce site visit requirements by CDC's planned date of July 1, 2023.

We recommend that the Centers for Disease Control and Prevention work with program recipients to implement a plan and timeline to: (1) conduct the required site visits that are overdue and (2) verify the completion of followup actions that had not been completed by the deadlines.

We recommend that the Centers for Disease Control and Prevention update its Provider Education, Assessment, and Reporting online system to include interactive reminders or alerts related to overdue site visits and followup actions.

We recommend that the Centers for Disease Control and Prevention complete the development and implementation of internal written policies and procedures for VFC program oversight activities, including oversight of program recipients' site visits to ensure that requirements are met.

We recommend that the Centers for Medicare & Medicaid Services instruct the MACs to, based on the results of this audit, notify 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 direct the MACs to recover from acute-care hospitals the portion of the $41,401,244 in identified overpayments for our audit period that are within the 4-year reopening period in accordance with CMS's policies and procedures.

OIG recommends that the Bureau of International Narcotics and Law Enforcement Affairs develop a coversheet for performance progress reports to ensure that reports are signed and certified by an authorized representative of the recipient organization and distribute it for use to the National Center for State Courts.

Require the Office of Regulations, Appeals, and Policy, in coordination with the Office of General Counsel, to determine whether the Office of Dentistry and the Consolidated Patient Account Center Program have appealable benefits decisions governed by the AMA, and if so, to update program policies, processes, and procedures accordingly, including ensuring that claimants receive written decision notices that meet all act requirements.

Require the Office of Regulations, Appeals, and Policy to evaluate the program offices’ barriers to including all required elements in decision notices and take corrective action, seeking congressional relief if needed.

Using the evaluation findings from recommendation 2, require Payment Operations to update its systems to generate AMA-compliant decision notices to the extent possible.

Using the same evaluation findings, require the Veteran and Family Member Programs to update its systems to generate AMA-compliant decision notices to the extent possible.

Require the Office of Regulations, Appeals, and Policy and the program office for Member Services’ Eligibility and Enrollment Division to ensure that priority group assignment decision notices are provided with enrollment handbooks given to veterans.