Open Recommendations

USAID/Philippines determine the allowability of $303,925 in questioned costs, ($1,467 of ineligible costs and $302,458 of unsupported) on pages 30 to 63 of the audit report and recover any amount that is unallowable.

USAID/Philippines verify that ADMU corrects the 8 material weaknesses in internal control detailed on pages 30 to 44 of the audit report.

USAID/Philippines verify that ADMU corrects the 5 instances of material noncompliance detailed on pages 32 to 33, and 36 to 44 of the audit report.

Rec. 1: The DoD OIG recommended that the Under Secretary of Defense for Personnel and Readiness, in coordination with the Assistant Secretary of Defense (Health Affairs), Defense Health Agency Director, Surgeon General of the U.S. Navy, and Command Surgeon of the U.S. Special Operations Command, review, update, and implement as needed drug testing policies related to performance?enhancing drugs, including DoD Instruction 1010.16, "Technical Procedures for the Military Personnel Drug Abuse Testing Program."

Rec. 2.a1: The DoD OIG recommended that the Commander of the Naval Special Warfare Command, reassess the Naval Special Warfare Center's medical capabilities. At a minimum, the assessment should determine if the Naval Special Warfare Center's medical and communication equipment supports the appropriate standard of care for candidates.

Rec. 2.a.2: The DoD OIG recommended that the Commander of the Naval Special Warfare Command reassess the Naval Special Warfare Center's medical capabilities. At a minimum, the assessment should determine if the Naval Special Warfare Center's medical manpower requirements meet clinical demand.

Rec. 2.b: The DoD OIG recommended that the Commander of the Naval Special Warfare Command, develop and implement a plan and policy to ensure that the Naval Special Warfare Center has sufficient resources based on the results of the assessment completed in Recommendation 2.a.

Rec. 3: The DoD OIG recommended that the Commander of the Naval Special Warfare Command develop and implement a sleep deprivation policy to establish written guidance using results from ongoing medical studies to provide functional guidance that will ensure operationally relevant training while minimizing safety concerns for Sea, Air, and Land and Special Warfare Combat Crewmen candidates during training.

CMS should impose additional restrictions on the use of diagnoses reported only on in-home HRAs or chart reviews that are linked to in-home HRAs for risk-adjusted payments. While there are general requirements and oversight in place for the MA risk adjustment payment.

CMS should conduct audits to validate diagnoses reported only on in-home HRAs and HRA-linked chart reviews.

CMS should determine whether select HCCs that drove payments from in-home HRAs and HRA-linked chart reviews may be more susceptible to misuse among MA companies.

We recommend that BIE require Havasupai Elementary School to develop and implement a plan to monitor the resolution and correction of identified deficiencies in accordance with abatement plan timelines.

We recommend that BIE require Havasupai Elementary School to implement staff training on the emergency management program as required by Indian Affairs policy.

We recommend that BIE assist Havasupai Elementary School with reviewing and analyzing all work orders in the facility management system related to the school and update work order status as needed to ensure an accurate facility management database.

We recommend that BIE assist Havasupai Elementary School with developing and implementing a staffing plan that considers alternative options to fill vacancies (e.g., interfacing with nongovernmental organizations to broaden the pool of available applicants).

We recommend that BIE require Havasupai Elementary School to develop and implement a plan to repair the other safety and health concerns identified in this report related to the heating, ventilation, and air conditioning and roof conditions, as well as institute an injury reporting system.

We recommend that BIE require Havasupai Elementary School to complete a memorandum of understanding with local emergency organizations as required by Indian Affairs policy.

We recommend that BIE require Havasupai Elementary School to implement fire safety procedures, track all required fire equipment maintenance, and train all staff on the use of fire extinguishers and other related fire safety equipment as required by the National Fire Protection Association and Federal regulations.

We recommend that BIE require Havasupai Elementary School to develop and implement a security plan as required by DOI policy.

We recommend that BIE expand its annual safety and health inspection guidance to include security requirements and measures.

We recommend that BIE require Havasupai Elementary School to until a dedicated maintenance worker is hired, ensure designated staff are trained to update the work orders.

We recommend that USAID's Office of Acquisition and Assistance Cost, Audit and Support Division/Contract Audit Management Branch verify that Crown Agents USA, Inc., corrects the three material
weaknesses in internal control detailed on pages 9 to 13 of the audit report.

We recommend that the Millennium Challenge Corporation verify that MCA-Nepal corrects the two instances of material noncompliance detailed on pages 65 to 68 of the audit report.

We recommend that the Centers for Medicare & Medicaid Services work with its plan sponsors to adjust or delete PDEs, as necessary, and determine the impact to the Federal Government related to the Medicare Part D total costs of $953,370 for drugs associated with our sample items for which payment was available under the Medicare Part A SNF benefit, which included $541,652 for drugs that were administered during Part D enrollees' Part A SNF stays.

We recommend that the Centers for Medicare & Medicaid Services work with its plan sponsors to adjust or delete PDEs, as necessary, and determine the impact to the Federal Government related to the Medicare Part D total costs of $953,370 for drugs associated with our sample items for which payment was available under the Medicare Part A SNF benefit, which included $541,652 for drugs that were administered during Part D enrollees' Part A SNF stays.