Open Recommendations

We recommend that the Centers for Medicare & Medicaid Services work with its plan sponsors to identify similar instances of noncompliance that occurred during our audit period and determine the impact to the Federal Government, which could have amounted up to an estimated $465,077,908 in Part D total cost, including $245,365,324 for drugs that were administered during enrollees' Part A SNF stays.

We recommend that the Centers for Medicare & Medicaid Services work with its plan sponsors to identify similar instances of noncompliance that occurred before and after our audit period and determine the impact to the Federal Government related to Part D total costs for drugs for which payment was available under the Medicare Part A SNF benefit.

We recommend that the Centers for Medicare & Medicaid Services provide plan sponsors with timely and accurate information, such as dates of covered Part A SNF stays, to reduce instances of inappropriate Part D payment for drugs for which payment is available under the Part A SNF benefit.

We recommend that the Centers for Medicare & Medicaid Services instruct SNFs to cooperate with plan sponsors to identify and prevent improper Part D payments for drugs for which payment was available under the Part A SNF benefit.

Rec. 1: The DoD OIG recommended that the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD, in coordination with the Under Secretary of Defense for Policy, develop and implement guidance for supplemental funding that includes a requirement for DoD Components to document the purpose of payments that use supplemental funds that are appropriated with a specific purpose, such as documentation supporting the use of the Disaster Emergency Fund Code value.

Rec. 2: The DoD OIG recommended that the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD, in coordination with the DoD Components, develop and implement effective internal controls to support fast-paced emergency payments that implement the supporting documentation requirements of the DoD 7000.14-R, "DoD Financial Management Regulation.

Rec. 3: The DoD OIG recommended that the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD, in coordination with the Assistant Secretary of the Army (Financial Management and Comptroller); the Assistant Secretary of the Navy (Financial Management and Comptroller); the Assistant Secretary of the Air Force (Financial Management and Comptroller); the Assistant Director, Office of Business Operations Chief Operating Officer and Chief Financial Officer and Comptroller for Defense Security
Cooperation Agency; and the Chief Financial Officer and Director, Program Analysis and Financial Management for the U.S. Transportation Command, review the supporting documentation of the 309 disbursement transactions, totaling $1 billion…

Rec. 3.a: The DoD OIG recommended that the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD, in coordination with the Assistant Secretary of the Army (Financial Management and Comptroller), review the supporting documentation of the 118 disbursement transactions, totaling $523.7 million in questioned costs, to determine whether the payments were accurate and supported the Ukraine assistance mission, and take appropriate actions to resolve any unsupported payments or payments that are not in support of the Ukraine mission.

(U) Rec. 3.b: The DoD OIG recommended that the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD, in coordination with the Assistant Secretary of the Navy (Financial Management and Comptroller), review the supporting documentation of the 112 disbursement transactions, totaling $303.4 million in questioned costs, to determine whether the payments were accurate and supported the Ukraine assistance mission, and take appropriate actions to resolve any unsupported payments or payments that are not in support of the Ukraine mission.

Rec. 3.c: The DoD OIG recommended that the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD, in coordination with the Assistant Secretary of the Air Force (Financial Management and Comptroller), review the supporting documentation of 62 disbursement transactions, totaling $166.8 million in questioned costs, to determine whether the payments were accurate and supported the Ukraine assistance mission, and take appropriate actions to resolve any unsupported payments or payments that are not in support of the Ukraine mission.

(U) Rec. 3.d: The DoD OIG recommended that the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD, in coordination with the Assistant Director, Office of Business Operations Chief Operating Officer and Chief Financial Officer and Comptroller for Defense Security Cooperation Agency, review the supporting documentation of the 15 disbursement transactions, totaling $424,171 in questioned costs, to determine whether the payments were accurate and supported the Ukraine assistance mission, and take appropriate actions to resolve any unsupported payments or payments that are not in support of the Ukraine mission.

Rec. 3.e: The DoD OIG recommended that the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD, in coordination with the Chief Financial Officer and Director, Program Analysis and Financial Management for the U.S. Transportation Command, review the supporting documentation of the 2 disbursement transactions, totaling $13.3 million in questioned costs, to determine whether the payments were accurate and supported the Ukraine assistance mission, and take appropriate actions to resolve any unsupported payments or payments that are not in support of the Ukraine mission.

Rec. 4: The DoD OIG recommended that the Assistant Secretary of the Navy (Financial Management and Comptroller) initiate a preliminary review of the potential Antideficiency Act violations resulting from our samples, and take appropriate actions based on the results of the review. The preliminary review should be completed in accordance with DoD Regulation 7000.14?R, "DoD Financial Management Regulation."

We recommend that USAID's Office of Acquisition and Assistance Cost, Audit and Support Division/Contract Audit Management Branch verify that Kimetrica, LLC, corrects the one material weaknesses in
internal control detailed on pages 8 and 9 of the audit report.

We recommend that USAID/Zimbabwe verify that Centre for Sexual Health and HIV/AIDS Research Zimbabwe corrects the one instance of material noncompliance detailed on page 21 of the audit report.

We recommend that USAID/Tanzania verify that Evangelical Lutheran Church in Tanzania corrects the one instance of material noncompliance detailed on pages 39 to 40 of the audit report.

OIG recommends that the Bureau of Administration, in coordination with the Bureau of Diplomatic Security, reevaluate the Vehicle Allocation Methodology and update the criticality scoring system to eliminate the retention bias toward armored vehicles located in high-threat environments. This evaluation should consider the relative weight of each factor within the criticality score and consider requiring justifications for the retention of low-usage, high-criticality vehicles to achieve a balanced score.

OIG recommends that the Bureau of Diplomatic Security develop and implement guidance requiring overseas posts to periodically assess the volume of special protective equipment and hazardous materials. The guidance should take into consideration usage rates and the criticality of each asset in order to determine the appropriate quantities needed for post operations and provide instructions for adjusting asset holdings based on the outcomes of the assessment.

OIG recommends that the Bureau of Diplomatic Security update the Foreign Affairs Handbook to include a requirement that posts develop and maintain written disposition plans, including emergency destruction plans, for all special protective equipment, hazardous materials, and armored vehicles.

OIG recommends that the Bureau of Diplomatic Security develop, implement, and distribute guidance to overseas posts on how to develop disposition plans, including emergency destruction plans, for special protective equipment, hazardous materials, and armored vehicles. The guidance should include details on key considerations to make during the planning process, such as determining which stakeholders to involve in the planning process; planning for a variety of evacuation scenarios; considering timelines and resources needed to ship items out of the country; calculating the timelines needed to destroy assets at post; ensuring security personnel have access to all materials, tools, equipment, and vendors…

Following the implementation of Recommendations 3 and 4, OIG recommends that the Bureau of Diplomatic Security develop and implement guidance requiring post Emergency Action Committees to periodically review and approve post disposition plans, including emergency destruction plans, and to determine whether updates or changes are needed.

OIG recommends that the Bureau of Diplomatic Security revise its emergency destruction procedures to describe all acceptable methods to destroy special protective equipment, including methods that can be employed in a limited evacuation timeframe, as well as the equipment and time needed to execute each step. The Bureau of Diplomatic Security should then distribute the updated guidance to all overseas posts.

OIG recommends that the Bureau of Diplomatic Security develop and implement guidance on the disposition of hazardous materials in an emergency evacuation scenario. The guidance should include steps that can be implemented in a limited evacuation timeframe and outline the equipment and time needed to execute each step. The Bureau of Diplomatic Security should then distribute the updated guidance to all overseas posts.

OIG recommends that the Bureau of Diplomatic Security revise its armored vehicle disposal procedures to better guide Department of State personnel on how to efficiently disable or destroy armored vehicles in an exigent evacuation scenario. These procedures should include details on the estimated time needed to complete each required step, which steps should be prioritized over others, and which steps may be skipped given limited time and resources. The procedures should also include guidance and visual aids applicable to all models of Department of State armored vehicles maintained worldwide.

OIG recommends that the Bureau of Diplomatic Security develop and implement training for post security personnel on acceptable practices for the disposition of special protective equipment, hazardous materials, and armored vehicles in an emergency evacuation scenario.