Open Recommendations

The Office of Programs should develop a system that calculates and tracks the portion of sickness payments subject to be recovered from potential 12(o) liens.

The Office of Programs should develop policies and procedures to validate that employees are accurately differentiating between infirmaries and Railroad Unemployment Insurance Act benefits subject to 12(o) liens and those not subject to 12(o) liens for beneficiaries.

The Office of Programs should develop controls to ensure that Railroad Unemployment Claims System codes are properly updated after the report of settlement.

The Office of Programs should update its policies and procedures to address the two 12(o) lien requirements defined in Code of Federal Regulations Title 20 Section 341.8, Termination of sickness benefits due to a settlement, dated September 8, 2006.

The Office of Programs should formally request that railroads stop using outdated forms in the 12(o) lien process to ensure consistency and accuracy of all transactions with outside entities, and to promote a uniform 12(o) lien process.

The Office of Programs should work with the Bureau of Field Service, to update the Field Operating Manual to correctly reference the financial management system at the time of this audit, Financial Management Integrated System, and remove references to obsolete systems, such as the Program Accounts Receivable System.

The Office of Programs should update the Division of Program Operations Manual to correctly reference the financial management system at the time of this audit, Financial Management Integrated System, and remove references to obsolete systems, such as the Program Accounts Receivable System.

The Office of Programs should develop controls to independently verify the outcome of a claimant’s settlement.

The Office of Programs should update policies to require claims examiners to request additional information when claimants indicate that they were not injured at work, but do not specify whether they are pursuing a settlement in the sickness application.

The Office of Programs should develop a control to require a review of the total lien value established in the agency’s financial system.

The Office of Programs should develop controls to monitor the output generated from the automatic referral system.

The Office of Programs should update their policies to ensure the annual status reports are sent for each case open against a railroad employer for more than three years, in accordance with policies.

The Office of Programs should formalize a training curriculum so employees can correctly handle 12(o) lien casework and maintain the integrity of data and records on file in all 12(o) lien cases, thereby recovering all funds to which the agency is entitled to reimbursement.

The Office of Programs should develop a method for recording the date the Railroad Retirement Board is notified of a 12(o) lien settlement.

The Office of Programs should develop an internal control to ensure that 12(o) lien receivables are established and collected timely, in accordance with applicable criteria.

The Office of Programs should develop an internal control to verify that all debts referenced on the daily lists generated by the RUIA Daily Claims Processing System are transferred to the Financial Management Integrated System by the Railroad Retirement Board’s contracted service provider.

The Office of Programs should update the language in its Division of Program Operations Manual to reflect terminology consistent with the lien reduction process in lieu of the term “waivers.”

The Office of Programs should update their policies for sending the letter requesting copies of billing documents as proof that the claimant paid the medical expenses related to the infirmity for which the employer was held liable; the letter to notify the employer that the claimant has provided evidence to result in a lien reduction; and the letter to notify the claimant of an investigation into medical expenses for a potential lien reduction to reflect the practice at the time of this audit.

The Office of Programs should develop internal controls to require supervisory approval for the submission of the letters sent to inform inquirers of the amount of Railroad Retirement Board’s claim to reimbursement once the supervisor has approved the reconciliation form calculating the amount owed by the claimant.

We recommend that the Centers for Medicare & Medicaid Services update applicable Medicare requirements to clarify which types of professional and public education overhead costs are unallowable (e.g., clarify whether the costs of meals provided to non-OPO employees for professional education and the costs of tickets to entertainment events purchased for the purpose of public education are unallowable), which could have saved Medicare an estimated $664,295 for professional and public education overhead costs during our audit period.

We recommend that the Centers for Medicare & Medicaid Services instruct Palmetto GBA to recover $72,208 in unallowable Medicare payments by adjusting the applicable OPOs' cost reports to correct the $148,750 of unallowable professional and public education overhead costs reported, consistent with relevant laws and the agency's policies and procedures.

Treasury OIG should follow-up with the Commonwealth of Virginia (Virginia) management on necessary reporting corrections. Specifically, Items Not Listed Above (INLA) description corrections are needed in the Contracts greater than or equal to $50,000, Grants greater than or equal to $50,000, Transfers greater than or equal to $50,000, and Direct Payments greater than or equal to $50,000 payment types. In addition, Treasury OIG should pursue obtaining documentation from Virginia management for Contracts greater than or equal to $50,000, Transfers greater than or equal to $50,000, Direct Payments greater than or equal to $50,000, Aggregate Reporting less than $50,000, and Aggregate…

The Commissioner, Wage and Investment Division, should develop processes and procedures to ensure that microfilm cartridges are destroyed in compliance with record destruction time frames.

We recommend that the Texas Department of Health and Human Services Commission refund the $1,776,003 Federal share to the Federal Government.

Treasury OIG should request missing documentation from the Commonwealth of the Northern Mariana Islands (CNMI) management and follow-up on necessary reporting corrections. Further, based on CNMI’s responsiveness to Treasury OIG’s requests and its ability to provide sufficient documentation, Treasury OIG should determine if a full scope audit is feasible.