Open Recommendations

Rec. 2.d: The DoD OIG recommended that the Army's Deputy Chief of Staff, G-4 (Logistics); Navy's Deputy Chief of Naval Operations for Fleet Readiness and Logistics; and Chief of the Logistics Readiness Division, Headquarters Air Force (Logistics, Engineering, and Force Protection) collaborate with Defense Logistics Agency Disposition Services to identify and implement training, educational sessions, or another solution to address the lack of trust in the accuracy of the condition codes for items the Military Services turn in to Defense Logistics Agency Disposition Services.

Rec. 2.e: The DoD OIG recommended that the Army's Deputy Chief of Staff, G-4 (Logistics); Navy's Deputy Chief of Naval Operations for Fleet Readiness and Logistics; and Chief of the Logistics Readiness Division, Headquarters Air Force (Logistics, Engineering, and Force Protection) establish an internal control mechanism such as monitoring or periodic assessments to ensure assignment of accurate condition codes on turn-in documentation to Defense Logistics Agency Disposition Services.

Rec. 2.f: The DoD OIG recommended that the Army's Deputy Chief of Staff, G-4 (Logistics); Navy's Deputy Chief of Naval Operations for Fleet Readiness and Logistics; and Chief of the Logistics Readiness Division, Headquarters Air Force (Logistics, Engineering, and Force Protection) review the Defense Logistics Agency Disposition Services report on inaccurate condition codes, take action to identify why the inaccurate condition codes occurred, and mitigate future inaccurate condition code assignments.

We recommend that the Deputy Secretary of Commerce ensure that the Chief Information Officer implement multi-factor authentication for access to all of the Department's NSS according to Committee on National Security Systems requirements.

Rec. 4.b: The DoD OIG recommended that the Army Deputy Chief of Staff for Logistics develop and implement clear and comprehensive implementation guidance for condition-based maintenance plus and predictive maintenance, ensuring to detail the roles and responsibilities of stakeholders, based on guidance provided by DoD Instruction 4151.22, "Condition-Based Maintenance Plus for Materiel Maintenance," August 14, 2020.

Rec. 4.c: The DoD OIG recommended that the Army Deputy Chief of Staff for Logistics develop and tailor training to the appropriate levels necessary to achieve effective condition-based maintenance plus and predictive maintenance implementation.

We recommend that CMS pursue legislative or regulatory changes to lower costs for both the Medicare program and beneficiaries, by equalizing payments as appropriate between provider based facilities and freestanding facilities for E&M services.

We recommend the DHS Chief Financial Officer comply with the PIIA requirement to report an improper payment and unknownpayment estimate of less than 10 percent for each program for which an estimate was published in the materials accompanying the annual financial statement by ensuring that FEMA continues to enhance internal control procedures over the Disaster Case Management and Urban Search & Rescue programs by:a. developing and implementing policies and procedures for establishingand defining documentation requirements;b. providing appropriate training to personnel responsible for developingand operating internal controls;c. ensuring the implementation and operating effectiveness of policies andprocedures over labor rate review and…

We recommend the DHS Chief Financial Officer ensure that DHS’ Risk Management and Assurance Division follow OMB requirementsfor agencies that do not comply with PIIA, as defined in OMB Circular A-123.

We recommend that the NOAA Deputy Under Secretary for Operations update policies and procedures to ensure user observation requirements are validated in advance of next-generation satellite system acquisitions.

We recommend that the NOAA Deputy Under Secretary for Operations assign responsibility and design a process for determining the relative priority of each NOAA user observation requirement.

We recommend that the NOAA Deputy Under Secretary for Operations ensure that NESDIS revises policies and procedures for assigning requirements to next-generation satellite programs.

CMS should develop its own source of race and ethnicity data.

CMS should use self-reported race and ethnicity information to improve data for current beneficiaries.

CMS should develop a process to ensure that the data are as standardized as possible.

CMS should educate beneficiaries about CMS's efforts to improve the race and ethnicity information.

We recommend that CAS update its Review Guide to conform with applicable Federal regulations and CAS internal policies and procedures.

We recommend that CAS take steps to ensure that branch chiefs and negotiators follow all Federal and internal CAS requirements.

We recommend that CAS include all federally required documents on checklists provided to the nonprofit organizations and on checklists used by CAS officials.

We recommend that CAS review its staffing levels and determine whether resources are aligned efficiently, and adjust as needed, to ensure that the indirect cost rate-setting process is conducted in a timely manner.

We recommend that CAS seek clarification on whether the policy of including executive compensation higher than the Level II statutory cap in its indirect cost pool calculation complies with Federal law and governmentwide policy.

We recommend that CAS ensure that negotiated final indirect cost rates are calculated based on actual costs.

NIH should specifically require grantees to provide trainings and maintain a written policy regarding investigators' disclosure of other support.

NIH should modify reporting mechanisms to require grantees to report whether investigators' significant financial interests and other support involve foreign entities.

NIH should conduct outreach to grantees with R13 conference grants to clarify requirements regarding the disclosure and review of investigators' significant financial interests and other support.

We recommend that the Centers for Medicare & Medicaid Services instruct the DME MACs to recover $41,137 in overpayments for PMD repairs made to PMDs that belonged to 76 sampled beneficiaries.

We recommend that the Centers for Medicare & Medicaid Services instruct the DME MACs to based upon the results of this audit, notify appropriate suppliers (i.e., those for whom CMS determines this audit constitutes credible information of potential overpayments) so that the suppliers 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.

We also recommend that the Centers for Medicare & Medicaid Services work with the DME MACs to do the following, which could have saved Medicare an estimated $7,948,182 during our audit period; Implement a system edit that applies to all PMD repairs and identifies PMD repairs for review of supplier documentation to help ensure that PMD repairs are adequately documented and that the PMD repair charges are reasonable and necessary.

We also recommend that the Centers for Medicare & Medicaid Services work with the DME MACs to do the following, which could have saved Medicare an estimated $7,948,182 during our audit period; Implement a system edit to determine whether PMD repair charges exceed the estimated cost to replace the PMDs being repaired.

We recommend that the Centers for Medicare & Medicaid Services establish Medicare requirements that: (1) include the documentation standards established by guidance for PMD repairs; (2) specify that accumulated costs of repairs made to power wheelchairs during their 5 year RUL must not exceed a certain threshold; and (3) specify that suppliers must provide warranties for repairs made to PMDs, which could have saved Medicare an estimated $3,739,346 during our audit period.

The FBI should clarify its policies regarding the approved methods for transmitting child sexual abuse material (CSAM) and other contraband to prosecutors and other government employees with a need to view the material in their official capacity.

Establish clearly defined and detailed roles, responsibilities, and processes for all SBA offices and officials responsible for managing and handling potentially fraudulent PPP loans to reduce the risk of ineligible applicants receiving PPP forgiveness and the risk of fraud and financial loss in the PPP and when implementing similar future programs.

Provide lenders formal guidance to effectively and consistently handle potentially fraudulent PPP loans and ensure lenders have sufficient guidance when implementing similar future programs.

Improve Agency systems to automate benefit computations and reduce the need for manual processing.

Develop a plan to fill and retain the allocated number of Office of Human Capital and Talent Management staff needed to fulfill its duties in the hiring and onboarding process.

Develop and disseminate policies for the revised civil service recruitment and hiring process and standard operating procedures for the modified Foreign Service staff hiring and onboarding processes.

Create a USAID-specific definition of skill gaps to address both competency and staffing skill gaps across its hiring mechanisms.

Finalize strategic workforce planning guidance, to include USAID's updated Strategic Workforce Plan, workforce planning Automated Directives System chapter, and materials to assist Agency operating units in identifying and addressing skill gaps.

Conduct an analysis to determine whether personnel tools-e.g., Talent Analytics, LaunchPad, the Workforce Planning Model, or the Competency Exploration for Development and Readiness-can be utilized to track skill gaps at both an Agency and operating unit level and implement changes as appropriate based on this analysis.

We recommend that Peoples Health Network refund to the Federal Government the $3,312,219 in estimated overpayments.

We recommend that Peoples Health Network 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 Peoples Health Network enhance 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 Vanderbilt University Medical Center improve procedures and provide education to staff to ensure that claims billed to Medicare are accurate

We recommend that Vanderbilt University Medical Center implement changes to its billing system to ensure that claims billed to Medicare are accurate.

Strengthen information system controls to make certain that complete and accurate claims information is transferred between applicable current and future Community Care payment systems and the Consolidated Patient Account Centers’ workflow tool and VistA patient treatment files.

Conduct an assessment to determine if staffing resources and workload are sufficiently aligned to process the anticipated volume of claims to be billed to veterans’ private health insurers and make adjustments as needed.

Establish controls to ensure staff and contractors follow existing requirements to test single adults for COVID-19 before transfer usingdomestic commercial flights.

Clarify existing COVID-19 testing policies to include modes of transportation and timeframes for mandatory testing beforetransport.

We recommend that the FWS resolve the questioned costs related to unsupported indirect costs totaling $435,624.

We recommend that the FWS work with the Department to develop and implement a mechanism to hold its staff accountable for following Federal regulations related to indirect costs and record retention, and its own SOPs.