Open Recommendations

Strengthen controls over the development and approval of tree, bush, and vine prices, and expand current review to include verification of the sufficiency and accuracy of supporting information.

Establish a policy that, when using information or data from any outside entity, FSA will conduct an accuracy and applicability review with the outside entity to ensure that the information or data provided is being used in accordance with its intended purpose and with FSA regulations and policies.

We recommend that MCS Advantage, Inc. refund to the Federal Government the $220,577 of net overpayments.

We recommend that MCS Advantage, Inc. identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before or after our audit period and refund any resulting overpayments to the Federal Government.

We recommend that MCS Advantage, Inc. continue its examination of its existing compliance procedures to identify areas where improvements can be made to ensure that diagnosis codes that are at high risk for being miscoded comply with Federal requirements (when submitted to CMS for use in CMS's risk adjustment program) and take the necessary steps to enhance those procedures.

We recommend that the Census Bureau revise Chapter D-5, Section 11 (b) Cost Moinitoring to address any unique procedures necessary for Fixed Fee projects.

Determine the allowability of the questioned transactions and recover
$5,538,037, if applicable.

Conduct a thorough assessment of single-celling policies and processes, including those applicable to inmates housed in quarantine and medical isolation units and to inmates vulnerable to suicide.

Assess how to improve staff and inmate compliance with healthcare protective equipment measures at its facilities and issue clear guidance to facilities about the importance of compliance.

Ensure that actions, including any policy revisions, the BOP takes to close the two open recommendations from our 2017 restrictive housing report that reference single-celling also apply to single-celling during quarantine and medical isolation.

Explore options for permanent changes to facility infrastructures that would allow for better implementation of social distancing and other infection control measures.

Immediately update guidance regarding (1) when staff should notify the families of inmates who become seriously ill or die, including a specific timeframe, and (2) uniform criteria for what constitutes a serious illness.

Ensure that inmate family information, or the inmate emergency contact form, is updated according to policy and readily available for BOP staff who need to notify next of kin in cases of inmate serious illness or death.

Create an RPS resource allocation and technology development strategic plan that includes an evaluation and mitigation of risks for each project through its completion and provide a communication plan to stakeholders and mission managers.

Conduct high quality, frequent, and routine self-assessment TRAs by project management beginning after the initial implementation of a technology development project as a basis for TRL assessment and risk management discussions.

Per Title 51 and NPR 7120.5F, recalculate the life-cycle costs for Next-Gen RTG and DRPS projects to include funding NASA provides to DOE.

Institute an EVM process for Next-Gen RTG and DRPS projects that conforms with NASA policy, FAR requirements, and industry best practices.

For Next-Gen RTG and DRPS development efforts that transition to a space flight project, execute a JCL analysis at the proper phases in accordance with NPR 7120.5F.

Reevaluate the need and if appropriate reauthorize the organizational position of the Nuclear Power and Propulsion System Capability Leadership Team through the appropriate Mission Directorate and provide the Team responsibility for monitoring and advocating strategic nuclear power coordination across NASA.

We recommend that the FWS work with the Department to resolve the Federal share of questioned costs related to unsupported leave payouts totaling $53,262.

We recommend that the FWS require the Department to implement policies and procedures to ensure that leave payouts are allocated based on activity charged to specific grants, as required by Federal regulations.

We recommend that the FWS require the Department to establish policies and procedures that ensure the Department minimizes the time between the drawdown date and related expenditures.

We recommend that the FWS require the Department to implement a process with sufficient internal controls to provide for a reconciliation of all grant claims to actual expenditures recorded in FAMIS, the official Statewide accounting system.

We recommend that the FWS require the Department to develop a mechanism to hold Department employees accountable for timely submitting Federal financial and performance reports.

We recommend that the FWS require the Department to implement policies and procedures that ensure the Department is calculating and reporting indirect costs using the approved indirect cost rates.

We recommend that the FWS require the Department to develop and implement procedures to ensure compliance with Federal regulations related to subaward reporting.

We recommend that the FWS work with the Department to develop and implement guidance for determining whether WSFR funds pass through as subawards or contracts.

We recommend that Geisinger Health Plan refund to the Federal Government the $566,476 of net overpayments.

We recommend that Geisinger Health Plan identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before and after our audit period and refund any resulting overpayments to the Federal Government.

We recommend that Geisinger Health Plan examine its existing compliance procedures to identify areas where improvements can be made to ensure that diagnosis codes that are at high risk for being miscoded comply with Federal requirements (when submitted to CMS for use in CMS's risk adjustment program) and take the necessary steps to enhance those procedures.

We recommend that the Georgia Department of Community Health work with providers to improve their facilities, staffing, and training.

We recommend that the Georgia Department of Community Health improve its oversight and monitoring of providers.

We recommend that the Georgia Department of Community Health ensure that providers correct the 312 instances of provider noncompliance identified in this report.

We recommend that the DOI establish and implement training on how to use required incident report systems and require all supervisors to attend.

We recommend that the DOI implement and require training for supervisors on how to review and analyze taser activity reports.

Information Security Continuous Monitoring

Information Security Continuous Monitoring

Supply Chain Risk Management

We recommend that the Georgia Department of Community Health refund to the Federal Government $644,802 (Federal share) for single-source physicianadministered drug claims that were ineligible for Federal reimbursement.

We recommend that the Georgia Department of Community Health refund to the Federal Government $9,325 (Federal share) for top-20 multiple-source physician-administered drug claims that were ineligible for Federal reimbursement.

We recommend that the Georgia Department of Community Health work with CMS to determine and refund the unallowable portion of $52,837 (Federal share) for other multiple-source physician-administered drug claims that may have been ineligible for Federal reimbursement and consider invoicing drug manufacturers for rebates for those drug claims that CMS determines are allowable;

We recommend that the Under Secretary of Commerce for Standards and Technology and Director of NIST change policy to ensure (1) UPI is strategically reinvested into MEP and (2) if UPI is not reinvested into MEP, withhold federal funds until UPI is used to pay down allowable project expenses.

We recommend that the Under Secretary of Commerce for Standards and Technology and Director of NIST conduct a thorough review of executive compensation for reasonableness as required by Departmental and NIST criteria.

We recommend that the Under Secretary of Commerce for Standards and Technology and Director of NIST establish policy limits on executive compensation for MEP, including restrictions on Center and subrecipient salaries.

We recommend that the Under Secretary of Commerce for Standards and Technology and Director of NIST establish procedures to (1) ensure recipients disclose in writing any potential conflict of interest to NIST consistent with award terms and (2) promptly review any such disclosures.

We recommend that the Under Secretary of Commerce for Standards and Technology and the Director of NIST review all disclosed related party activities identified by us and previously reported to NIST and take any action deemed appropriate.

We recommended that Centers for Medicare and Medicaid Services direct the MACs (or other CMS-designated entities) to review a sample of claims for epidural steroid injection sessions administered during the period beginning on January 1, 2021, and ending on the date that the revised coverage limitations (i.e., up to four sessions per 12-month period) became effective in the relevant MAC's jurisdiction (I.e. December 5, 2021, and June 19, 2022), to identify instances in which Medicare paid physicians for injection sessions that exceeded the number of allowable sessions (in accordance with the applicable LCDs) and recover any improper payments identified.

We recommend that the Centers for Medicare and Medicaid Services direct the MACs to recover the $3,585,422 in improper payments made to physicians for epidural steroid injection sessions.

We recommend that the Centers for Medicare and Medicaid Services instruct the MACs to, based on the results of this audit, notify appropriate physicians (i.e. those for whom CMS determines this audit constitutes credible information of potential overpauments) so that the physicians 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.

Direct SNL to ensure MESA procurements of weapon products for use in nuclear weapons production are clearly identifiable in its records system and includes necessary attributes.