Open Recommendations

In our February 2024 alert, we recommended that the Director, Field Assistance, and Chief, Facility Management and Security Services, take action to address the issues identified regarding the lack of security measures to ensure that taxpayers are being provided appropriate taxpayer services, and protect IRS employees and taxpayers when visiting the TACs. Additionally, processes should be implemented to ensure that all security guards are aware of their responsibilities when interacting with taxpayers to include mandatory security screening policies and refraining from impeding a taxpayer’s ability to speak with IRS employees.

In our February 2024 alert, we recommended that the Director, Field Assistance, ensure there is a consistent policy regarding whether appointments are necessary or if walk-ins will be accommodated to avoid confusion and provide a consistent experience at all TAC locations.

In our February 2024 alert, we recommended that the Director, Field Assistance, ensure all TAC employees are aware of the policies regarding walk-in taxpayers as they relate to services provided, ensure employees are aware and educated on programs offered by the IRS that will ensure that taxpayers are afforded the necessary information to obtain free services that will assist them in compliancy, and finally ensure a policy where TAC employees have the ability to print off the necessary forms requested by a taxpayer.

The Chief, Taxpayer Services, should develop processes and procedures to ensure that services offered at the TACs, including those to be provided to taxpayers without an appointment, are consistent and in conformance with internal guideline requirements. These processes and procedures should include verification steps to be taken as part of the IRS’s annual filing season readiness confirmation processes.

The Chief, Taxpayer Services, should perform a cost-benefit analysis to ensure a business need, including a benefit to the taxpaying public, continues to exist in providing local TAC telephone lines.

The Chief, Taxpayer Services, should develop processes and procedures to ensure the accuracy and consistency of recorded messages while local telephone lines continue to be in place. These processes and procedures should include verification steps to be taken as part of the IRS’s annual filing season readiness confirmation processes.

We recommend that USAID/West Africa determine the allowability of $39,329 in unsupported costs on pages 11, 12 to 14 of the audit report and recover any amount that is unallowable.

We recommend that USAID/West Africa verify that National Episcopal Conference in Cameroon corrects the four material weaknesses in internal control detailed on pages 17 to 21 of the audit report.

We recommend that USAID/West Africa verify that National Episcopal Conference in Cameroon corrects the two instances of material noncompliance detailed on pages 21 and 22 of the audit report.

We recommend that USAID/Southern Africa determine the allowability of $25,847 in ineligible questioned costs on page 20 of the audit report and recover any amount that is unallowable.

We recommend that the Mental Health Center of Florida monitor and evaluate the effectiveness of the QA program updates to ensure that documenting of time spent on psychotherapy services meets Medicare requirements.

We recommend that the Mental Health Center of Florida monitor and evaluate the effectiveness of the QA program updates to ensure that documenting of time spent on psychotherapy services meets Medicare requirements.

We recommend that the Massachusetts Executive Office of Health and Human Services recover from IMDs and CBDCs $21,606,437 in SNCP payments that exceeded the cost of caring for Medicaid and uninsured patients.

We recommend that the Massachusetts Executive Office of Health and Human Services correct its $6,239,386 overstatement of CPEs on the CMS-64, which represents the difference between its CPE estimates and the actual uncompensated care provided to uninsured patients for State-owned hospitals.

We recommend that the Massachusetts Executive Office of Health and Human Services refund to the Federal government the $13,922,912 Federal share of the total $27,845,823 in SNCP expenditures that did not comply with Federal requirements.

We recommend that the Massachusetts Executive Office of Health and Human Services develop and implement policies and procedures that instruct personnel to perform interim and final reconciliations required by the STCs.

We recommend that the Massachusetts Executive Office of Health and Human Services perform reconciliations for the SFYs following our audit period, where the required Medicare cost reports or UFRs are available. In addition, it should refund the Federal share of any oversated CPEs, as well as recover any overpayments to IMDs and CBDCs and refund the Federal share.

We recommend that, for items or services for which the Medicare program establishes a quantity limit, CMS use the results of this audit to research and determine the best method(s) (e.g., nationwide system edits, information-sharing between providers, and other mechanisms) to detect and prevent improper payments to providers.

OIG recommends that OST determine the allowability of the questioned transactions and recover $933,026 if applicable.

OIG recommends that OST work with the Federal Highway Administration to determine the allowability of questioned tribal transactions and recover $5,803,740, if applicable.

OIG recommends that OST work with the Federal Transit Administration to determine the allowability of questioned tribal transactions and recover $136,402, if applicable.

Rec. 1.c: The DoD OIG recommended that the Director, Defense Health Agency perform a review of the $1 million in payments that the managed care support contractors paid for health care services provided from FYs 2019 to 2023 that did not meet the Defense Health Agency-established age limits list, and recoup where applicable. As part of the review, assess the managed care support contractors' medical review process when determining whether the managed care support contractors paid for services and items in compliance with the Defense Health Agency-established age limits list.

Rec. 1.d: The DoD OIG recommended that the Director, Defense Health Agency perform a review of the $26.3 million in questioned costs that the managed care support contractors paid for pediatric enteral formula provided from FYs 2019 to 2023 in which the Defense Health Agency-established aged limits list did not meet the pediatric description as defined by the Centers for Medicare and Medicaid Services and age limits identified within product labeling and medical literature. Initiate recoupment of the payments if the Defense Health Agency determines that the managed care support contractors should not have paid for the pediatric enteral formula.

Rec. 1.a: The DoD OIG recommended that the Director, Defense Health Agency, modify the managed care support contracts or TRICARE guidance to explicitly require the TRICARE managed care support contractors to use the Defense Health Agency-established age limits list for all claims.

Rec. 1.b: The DoD OIG recommended that the Director, Defense Health Agency perform a one-time review to ensure that all existing age limits within the Defense Health Agency-established age limits list match age limits established by the American Medical Association and Centers for Medicare and Medicaid Services, where applicable, and revise the age limits accordingly.

Rec. 1.e: The DoD OIG recommended that the Director, Defense Health Agency revise Defense Health Agency policy to require the Defense Health Agency to perform an annual review of high-risk payments in which managed care support contractors paid claims for health care services and items provided in FY 2024 and future years that did not meet the Defense Health Agency-established age limits list requirements.

Rec 1.a: The DoD OIG recommended that the Assistant Secretary of the Army (Manpower and Reserve Affairs), in coordination with the Commanding General of the Army Training and Doctrine Command conduct a review to determine how trainees entered the Assessment of Recruit Motivation and Strength 2.0 pilot program above the allowable initial entry body fat composition standards.

Rec. 1.b: The DoD OIG recommended that the Assistant Secretary of the Army (Manpower and Reserve Affairs), in coordination with the Commanding General of the Army Training and Doctrine Command develop and implement procedures to ensure the applicants entering the Assessment of Recruit Motivation and Strength 2.0 pilot program meet the authorized body fat percentages.

Rec. 2.a: The DoD OIG recommended that the Commanding General of the Army Training and Doctrine Command, in coordination with the Commanding General of the Army Training Center and Fort Jackson, review resourcing deficiencies within the medical resources dedicated to the Assessment of Recruit Motivation and Strength 2.0 pilot program to develop and implement a plan to meet the medical service requirements for the program.

Rec. 2.b: The DoD OIG recommended that the Commanding General of the Army Training and Doctrine Command, in coordination with the Commanding General of the Army Training Center and Fort Jackson, review resourcing deficiencies within the medical resources dedicated to the Assessment of Recruit Motivation and Strength 2.0 pilot program to develop and implement a plan to manage the number of Assessment of Recruit Motivation and Strength 2.0 pilot program trainees based on the availability of medical resources.

Establish requirements for complete and current Division approvals of State Department of Transportation (State DOT) construction quality assurance programs.

Implement controls to ensure that all applicable construction quality assurance program documents used on State DOT and locally-administered National Highway System (NHS) projects are approved by Divisions and referenced in Stewardship and Oversight Agreements as required.

Require Divisions to develop and implement written procedures for conducting appropriate oversight of State DOT construction quality assurance programs and addressing the minimum oversight areas as described in FHWA's 2006 policy on construction quality assurance.

Assess the project materials certifications related to the $24.3 million in questioned costs we identified. Develop an action plan to confirm that materials submitted under these certificates conform to required standards and take appropriate remedial action, if necessary.

Develop and implement guidance for Divisions' review of materials certifications, including verification that certifications conform to required standards, and establish a uniform definition for exceptions that State DOTs should report.

Update the Agency's guidance on construction monitoring to establish minimum requirements for Divisions' oversight on construction inspection.

Assess the risk of construction quality assurance on locally-administered NHS projects whose local agencies are direct recipients of Federal-aid funds and implement actions to mitigate risks.

Update the Agency's construction quality assurance stewardship review process to address all aspects of compliance and Division oversight. The updated process should address the tracking of States' compliance status and Divisions' required oversight activities.

Update the Agency's construction quality assurance assessment process to incorporate a systematic assessment of fraud risks affecting the program.

Develop and implement an Agencywide construction quality assurance fraud risk strategy, with associated guidance and training, that Divisions can use to prevent, detect, and respond to fraud risks.

Update the Agency's webpage on detecting and reporting fraud in consultation with the Office of Inspector General to correct inaccurate and out-of-date information.

Update FHWA construction quality assurance related webpages to correct out-of-date information.

Implement controls for maintaining current and complete construction quality assurance information on FHWA's website, including program office webpages and those on the Policy and Guidance Center.

We recommend that the Colorado Department of Health Care Policy and Financing refund $6,012,198 to the Federal Government, consisting of $3,509,358 (Federal share) of capitation payments made on behalf of deceased enrollees who had a date of death recorded in SSA's DMF but not in the State agency's eligibility system; $293,890 (Federal share) of capitation payments made on behalf of deceased enrollees who had a date of death recorded in SSA's DMF and in the State agency's eligibility system; and $2,208,950 (Federal share) in other Medicaid expenditures that the State agency had previously overreported.

We recommend that the Colorado Department of Health Care Policy and Financing refund $6,012,198 to the Federal Government, consisting of $3,509,358 (Federal share) of capitation payments made on behalf of deceased enrollees who had a date of death recorded in SSA's DMF but not in the State agency's eligibility system; $293,890 (Federal share) of capitation payments made on behalf of deceased enrollees who had a date of death recorded in SSA's DMF and in the State agency's eligibility system; and $2,208,950 (Federal share) in other Medicaid expenditures that the State agency had previously overreported.

We recommend that the Department require FWS, IBC, NPS, OSMRE, and OWPO to reevaluate the risk for current grants awarded to the Illinois Department of Natural Resources in accordance with 2 C.F.R. 200.206(c).

We recommend that the Department require FWS, IBC, NPS, OSMRE, and OWPO to develop and implement a monitoring plan that sufficiently addresses the increased risk with the Illinois Department of Natural Resources and determine the necessary adjustments or enhancements to oversight mechanisms on future DOI awards in accordance with 2 C.F.R. 200.206(b).

Establish a plan to use VAs cost accounting system information to identify additional ways to reduce costs, enhance efficiency, and inform business decisions as identified by VA financial policy

Ensure the facility has a process to identify cost outliers, such as using the Intermediate Product Cost Outlier report to identify cost outliers that may occur at the healthcare system on a regular basis.

Ensure healthcare system service lines review and update the national labor mapping tool to the Veterans Integrated Service Network managerial cost accounting team as required by VA financial policy to ensure workload is being captured correctly.