Open Recommendations

The District Director determines reasons for lack of evidence that clinical quality review deficiencies were resolved at the Columbia, Fargo, Omaha, and Sioux Falls Vet Centers, takes indicated actions to ensure completion, and monitors compliance.

Implement a single Software Asset Management tool across the Agency.

Centralize software spending insights to include purchase cards.

We recommend the DHS Chief Information Officer develop and execute a separate plan for implementing DHS’ geospatial data strategy or ensure the implementation plan developed for the Department’s Evidence-Based Data Strategy fully considers geospatial data and is consistent with the Geospatial Data Act of 2018.

We recommend the DHS Chief Information Officer pursue a legislative approach, concurrent with existing administrative efforts, for determining how DHS handles, secures, and shares sensitive-but unclassified geospatial data. As appropriate, the effort should be conducted in coordination with internal DHS stakeholders and in combination with any similar efforts undertaken by other agencies.

We recommend the DHS Chief Information Officer confirm that all the platforms on which DHS shares geospatial data are following appropriate geospatial metadata standards.

Improve the coordination and procedures for the NSF offices involved in the Intergovernmental Personnel Act assignee vetting process to ensure issues identified during the process are elevated to an appropriate office or position for resolution.

Strengthen the vetting process for Intergovernmental Personnel Act assignees to address foreign influence-related issues.

We recommend that the Assistant Secretary for Export Enforcement implement policies and procedures to monitor and track firearm qualifications and training, which includes centralized monitoring by those responsible for ensuring compliance with requirements.

We recommend that the DHS Chief Security Officer clarify policies and procedures to require managers to notify security officials to revoke personal identity verification cards and withdraw security clearances within a specific timeframe after individuals separate from DHS.

We recommend that the DHS Chief Security Officer strengthen internal processes to ensure accountability and oversight for all personal identity verification cards that are collected and destroyed when individuals separate from DHS.

We recommend that the DHS Chief Security Officer implement additional controls to ensure personal identity verification card revocation and card destruction are completed and recorded when individuals separate from DHS.

We recommend that the DHS Chief Security Officer implement controls to ensure DHS officials record security clearance withdrawal dates in the Integrated Security Management System when individuals separate from DHS.

We recommend that the DHS Chief Security Officer develop and implement a solution to verify and validate the personal identity verification card access termination process across the Department and a mechanism to monitor its effectiveness.

We recommend that the DHS Chief Security Officer develop and implement a solution to verify and validate the security clearance withdrawal process across DHS and a mechanism to monitor its effectiveness.

We recommend the U.S. Customs and Border Protection, Office of Field Operations, Executive Assistant Commissioner take immediate action to ensure the Blaine Command Center is connected to adequate emergency back-up power. To accomplish this, CBP should work closely with the U.S. General Services Administration to determine the most efficient and effective method for connecting the Blaine Command Center to adequate emergency back-up power.

We recommend the U.S. Customs and Border Protection, Office of Field Operations, Executive Assistant Commissioner take immediate action to ensure video surveillance camera equipment at the Pacific Highway and Peace Arch land ports of entry is connected to adequate emergency backup power. As part of U.S. Customs and Border Protection’s corrective action plan, it should consider assessing its operational areas at the Pacific Highway and Peace Arch land ports of entry to determine any additional equipment requiring connection to adequate emergency back-up power.

We recommend the U.S. Customs and Border Protection, Office of Field Operations, Executive Assistant Commissioner: conduct assessments at its land ports of entry to identify video surveillance camera equipment not connected to adequate emergency back-up power as required; and develop and implement a strategy to fund and timely resolve issues identified during the assessment of land ports of entry.

We recommend that the Department prioritize the inventory, monitoring, and enforcement of existing controls as well as the controls we recommended in this report for accounts belonging to senior Government employees or accounts with elevated privileges.

We recommend that the Department establish procedures and accountability mechanisms to ensure compliance with policies regarding account management monitoring and timely disabling of inactive accounts.

Ensures the Chief Information Officer plans, conducts, and reports on a full failover test of the NCUA’s IT network to identify and correct any identified weaknesses.

We recommend that the BIA resolve the questioned costs of $10,792 by requiring the Omaha Tribe to reallocate these costs to the appropriate funding source.

We recommend that the BIA require the Omaha Tribe to revise its policy to ensure a complete property record for CARES Act-funded assets in accordance with 2 C.F.R. 200.313(d)(1).

Ensure that the IRS does not burden taxpayers in existing payment agreements when PCA contracts are ending by developing a solution to continue to service taxpayers in active payment arrangements.

We recommend that Cigna-HealthSpring of Tennessee, Inc. refund to the Federal Government the $5,987,509 of estimated overpayments.

We recommend that Cigna-HealthSpring of Tennessee, Inc. 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 Cigna-HealthSpring of Tennessee, 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.

CMS should build a strategy to strengthen its internal controls for ensuring the accuracy of Part B drug payments.

CMS should actively review current guidance related to the areas identified in this report and determine whether additional guidance would ensure more accurate and consistent ASP calculations.

We recommend the Office of the Secretary establish aDHS oversight entity to ensure National Instant Criminal Background CheckSystem compliance in DHS, which should include:a. coordinating with the Attorney General to resolve open dispositions thatno longer have available information and discontinue use ofadministrative closure dispositions; andb. developing a risk-based strategy for components to assess missingcriminal history records and submit missing dispositions.

We recommend the DHS Office of the Secretary establisha mechanism to track and ensure timely responses to NICS inquiries anddevelop and implement a process to include immigration status at the time ofinquiry for immigration-related inquiries.

We recommend the United States Coast Guard,Assistant Commandant for Human Resources, establish a process for thePersonnel Service Center to notify the Coast Guard Investigative Service of thecompletion of dishonorable discharges and that CGIS personnel enter theminto NICS data.

Perform a comprehensive, enterprise-wide assessment, with input from each division, to identify the operational technology threats to the FBl's investigative and business practices develop options for an FBI-wide approach to mitigate each of the threats identified; identify and report these options and the results of the assessment to the Deputy Director to use in developing and assigning responsibility for the FBl's enterprise-wide strategy for managing this risk.

Fully implement an enterprise-wide training plan for mitigating the threat posed to FBI investigations, personnel and sources by changing operational technologies. This training plan should include a baseline training for all employees, including non-agent personnel, It should also include appropriate refresher training on a regular basis.

Work with ACF to develop a viable plan for refunding $153,052 in unallowable costs to the Federal Government.

Develop and implement procurement policies and procedures to avoid acquiring unnecessary items and to perform analyses to determine the most reasonable approach for future vehicle purchases.

Develop and implement written policies and procedures to ensure that criminal background checks on employees are completed within required time frames.

We recommend that the State agency refund up to $9,832 to the Federal Government.

We recommend that the State agency enhance the monitoring of provider compliance by conducting periodic reviews of telehealth payments for compliance with requirements.

We recommend that the State agency establish a list of acceptable telehealth procedure codes.

(U) Transfer to the Stagehand program the field division FSL already used by Stagehand or determine an alternative approach that gives Stagehand appropriate control over its staffing to ensure the operational effectiveness, continuity, and security of the Stagehand program.

(U) Work with NSD and other Department stakeholders to develop an integrated system for tracking requests for AGEs and Otherwise Illegal Activity from initiation through final approval that can meet the FBl's and the Department's operational needs, provide visibility about the status of a given request. and identify specific and systemic delays in the AGE and Otherwise Illegal Activity approval process.

(U) Establish reasonable and attainable qualifications for UCCs to better ensure UCCs have appropriate undercover experience, grade level. and adequate time to effectively conduct their undercover-related
duties. Once the UCC qualifications are established, the FBI should update its policies and procedures to reflect the new requirements.

We recommend that Keystone First HealthChoices coordinate with the Pennsylvania Department of Human Services, Office of Medical Assistance Program, to update Keystone First's administrative process to require that medical directors assess whether overnight care requests meet the medical necessity requirement based on the documentation Keystone First has received even if some documentation, such as the caregiver's work verification documentation, is missing.

Review all pediatric skilled nursing service requests for which overnight care was completely denied and determine whether the overnight care requests meet the medical necessity requirement regardless of whether the caregiver provided work or school verification documentation.

Implement a revised initial denial notice to explain that a beneficiary has the right to request a State fair hearing after exhausting the MCO's appeals process.

We recommend that the Pennsylvania Department of Human Services, Office of Medical Assistance Program, revise the initial denial notice template referenced under Exhibit N in the HealthChoices Agreement to include information regarding the beneficiary's right to request a State fair hearing after exhausting the MCO's appeals process.

We recommend that CMS update the HH Pricer logic to check for missing and invalid FIPS codes on all home health claims and work with MACs to ensure that these claims are returned to providers for correction.

We recommend that CMS re-educate providers on the requirement for all home health claims to be submitted with the FIPS code for the county where the service was provided.

In a timely manner, ensure that complaints are filed with the relevant state appraiser licensing authorities for each appraisal from its December 2021 review in which FHFA found overt references to race, color, and other prohibited bases.