Open Recommendations

To ensure that the State agency complies with Federal requirements and does not claim unallowable costs, we recommend that the Centers for Medicare & Medicaid Services direct the State agency to revise the Process Guide to prohibit the substitution of sampled personnel.

To ensure that the State agency complies with Federal requirements and does not claim unallowable costs, we recommend that the Centers for Medicare & Medicaid Services direct the State agency to revise the Process Guide to revise the definition of the RMTS code described in the report to include only activities necessary for the proper and efficient administration of the Medicaid State plan.

To ensure that the State agency complies with Federal requirements and does not claim unallowable costs, we recommend that the Centers for Medicare & Medicaid Services direct the State agency to revise the Process Guide to require the collection of information (e.g., student names or case numbers) to support whether an RMTS respondent’s time was part of a health care service or a Medicaid administrative activity.

To ensure that the State agency complies with Federal requirements and does not claim unallowable costs, we recommend that the Centers for Medicare & Medicaid Services direct the State agency to revise the Process Guide to develop a method for allocating health care services costs to Medicaid that does not require it to rely on IEP and MP ratios (e.g., require a school district to determine whether an RMTS moment is for a health care service or administrative activity performed for a student enrolled in Medicaid).

Develop and implement a process to provide new OSCO members with adequate training and guidance with input from experiencedcollectors or the Intelligence Training Academy.

Establish and implement a process to request and receive timely reviews for open source intelligence products when they relate toupcoming events or urgent threats.

We recommend the Senior Official Performing the Duties of the Under Secretary for the Science and Technology Directorate, in consultation with the Office of Procurement Operations, develop and implement a process to ensure required special clauses are included in contracts for project acquisitions with a high risk of unauthorized access to or disclosure of sensitive information.

OIG recommends that U.S. Embassy Cairo, Egypt, develop and implement a standard operating procedure outlining the minimum type of work that should be performed for each make-ready project and the conditions that should be considered before completing additional work or if further approval is required before completing the work.

OIG recommends that Embassy Cairo, Egypt, discontinue the practice of using carryover funds for make-ready projects, and that it accounts for supplies, tools, and equipment used in support of its make-ready projects under the make-ready sub-cost center, consistent with the guidance outlined in 6 Foreign Affairs Handbook-5 H-341.15-11(B), Residential Make-Ready " Budgeted Costs.

(U) Rec. 1: The DoD OIG recommended that the Director of the Critical Technology Protection Directorate, Office of the Under Secretary of Defense for Intelligence and Security, update DoD Manual 5220.32, Volume 1, "National Industrial Security Program: Industrial Security Procedures for Government Activities," effective August 1, 2018, to reflect Federal Acquisition Regulation Subpart 4.4, "Safeguarding Classified Information Within Industry," requiring the use of the National Industrial Security Program Contract Classification System.

Develop requirements for acquiring the necessary staff and technology resources for managing records scheduling, disposition, access, and storage

We recommend that the Centers for Medicare & Medicaid Services do the following, which could have saved Medicare an estimated $47.8 million during our audit period:   -Educate hospitals on the NCD requirements for bariatric surgeries if the NCD has been updated in response to our first recommendation.

Establish controls to periodically review and reconcile Veterans Health Information Systems and Technology Architecture address data used to mail first-party billing statements.

The OIG has determined that the contents of this recommendation would not be appropriate for public disclosure and has therefore limited its distribution to selected officials.

The OIG has determined that the contents of this recommendation would not be appropriate for public disclosure and has therefore limited its distribution to selected officials.

The OIG has determined that the contents of this recommendation would not be appropriate for public disclosure and has therefore limited its distribution to selected officials.

The OIG has determined that the contents of this recommendation would not be appropriate for public disclosure and has therefore limited its distribution to selected officials.

Define and communicate policies and procedures to ensure that its products, system components, systems, and services comply with its cybersecurity and SCRM requirements. This recommendation includes:

The OIG has determined that the contents of this recommendation would not be appropriate for public disclosure and has therefore limited its distribution to selected officials.

The OIG has determined that the contents of this recommendation would not be appropriate for public disclosure and has therefore limited its distribution to selected officials.

The OIG has determined that the contents of this recommendation would not be appropriate for public disclosure and has therefore limited its distribution to selected officials.

The OIG has determined that the contents of this recommendation would not be appropriate for public disclosure and has therefore limited its distribution to selected officials.

The OIG has determined that the contents of this recommendation would not be appropriate for public disclosure and has therefore limited its distribution to selected officials.

The OIG has determined that the contents of this recommendation would not be appropriate for public disclosure and has therefore limited its distribution to selected officials.

The OIG has determined that the contents of this recommendation would not be appropriate for public disclosure and has therefore limited its distribution to selected officials.

The OIG has determined that the contents of this recommendation would not be appropriate for public disclosure and has therefore limited its distribution to selected officials.

The OIG has determined that the contents of this recommendation would not be appropriate for public disclosure and has therefore limited its distribution to selected officials.

The OIG has determined that the contents of this recommendation would not be appropriate for public disclosure and has therefore limited its distribution to selected officials.

Rec. 2: The DoD OIG recommended that the Under Secretary of Defense for Intelligence and Security develop procedures for sharing derogatory information on Afghan evacuees with the Department of Defense and interagency stakeholders.

Direct the Office of Infrastructure to follow the FHWA Emergency Relief (ER) Manual regarding deallocations of unobligated funds.

Update the ER Manual's quick release procedures to clarify the documentation needed for funding approval and the responsibilities to maintain sufficient evidence of required approvals for quick release requests submitted in accordance with emergency relief policy and program requirements.

Update the ER Manual to incorporate the requirements in FHWA Order 5182.1, including the routine review of unobligated balances so that funds can be deallocated when no longer needed.

Implement a standard process to approve initial business plans and monitor to ensure that business plans are reviewed annually, to include appropriate updates for specific targets, objectives, and goals for the business development of program participants, in accordance with 13 CFR 124.403(a) and section 7(j)(10)(D) of the Small Business Act.

Implement a standard process to capture, track, and recognize substantial achievement of the specific targets, objectives, and goals for the areas of finance, marketing, and management on 8(a) program participant business plans, in accordance with 13 CFR 124.112(f) and section 7(j)(10)(A) of the Small Business Act.

Establish outcome-based performance goals and measurements to assess whether the program achieved business development objectives, including the number of graduated 8(a) firms in accordance with the measure of success in section 101(b)(2) of the Business Opportunity Development Reform Act of 1988.

Implement a process to ensure the systematic collection of accurate and complete data on program results and operations to make sure all program reporting requirements are met,in accordance with section 7(j)(16)(A) of the Small Business Act and Standards for Internal Control in the Federal Government Principles for Information and Communication.

Implement requirements for management to monitor that Business Opportunity Specialists consistently assess program participant’s development needs, counsel participants, conduct annual field visits, and maintain required documentation, as required by standard operating procedures.

We recommend that Tufts Health Plan refund to the Federal Government the $3,758,335 of net overpayments.

We recommend that Tufts Health Plan 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 Tufts Health Plan continue to improve its existing compliance procedures to identify areas where improvements can be made to ensure 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.

OIG recommends that the Bureau of the Comptroller and Global Financial Services develop and implement a methodology to periodically review and update the budget object codes (BOC) included in the Foreign Affairs Handbook (4 FAH-1 H-613). This methodology should include collaborating with other bureaus to assist in identifying BOCs that are not needed, new BOCs that bureaus believe would be beneficial, or changes to the definitions of existing BOCs.

We recommend that the Office of Refugee Resettlement issue guidance to care provider facilities regarding the requirement to include all relevant ORR and DHS contacts in their emergency contact lists.

Ensure AVP implements written performance reporting policies and procedures to ensure its reports are accurate, submitted timely, and reflect an appropriate share of accomplishments towards achieving federally assisted activities.

Ensure AVP implements written policies and procedures to ensure program costs are approved by OVW, allocable to the grant, and supported with adequate documentation necessary to demonstrate compliance with its purchasing procedures and the federal grant requirements.

Ensure AVP implements policies and procedures to ensure compliance with its federal grant award conditions.

Ensure AVP implements written federal grant administration policies and procedures to ensure compliance with the DOJ Grants Financial Guide and other federal grant award requirements.

Remedy $601,578 in unsupported personnel expenditures.

Remedy $4,848 in unallowable pre-award personnel and fringe expenditures.

Ensure AVP implements written policies and procedures to ensure personnel expenditures charged to its federal grants are based on records that accurately reflect work performed and support a reasonable allocation or distribution of costs among specific activities or cost objectives when recipients work on multiple grant programs or cost activities.

Remedy $78,667 in unsupported fringe benefits expenditures.