Open Recommendations

We recommend the DHS Office of the Secretary ensure ICE, FPS, CBP, and TSA fully implement DNA collection for arrestees and nonU.S. detainees to comply with the DNA Fingerprint Act of 2005 and 28 C.F.R § 28.12.

We recommend the DHS Office of the Secretary ensure ICE, FPS, CBP, and TSA implement internal controls, including modifying booking systems to track and verify DNA collection. If components pursue memorandums of agreement with other agencies to collect DNA samples, they must implement internal controls to track and verify DNA collection.

We recommend the Acting Director of ICE ensure that before removing parents who have minor children in the United States, ICE staff document and obtain supervisory acknowledgement for each parent’s preference for whether the children should remain in the United States or be removed with the parent.

We recommend that Alive Hospice, Inc.: • refund to the Federal Government the portion of the estimated $7,389,854 for hospice services that did not comply with Medicare requirements and that are within the 4-year reopening period

We recommend that Alive Hospice, Inc.: • based upon the results of this audit, 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; and

We recommend that Alive Hospice, Inc. strengthen its policies and procedures to ensure that hospice services comply with Medicare requirements.

We recommend that Ambercare Hospice, Inc. based upon the results of this audit, 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; and

We recommend that Ambercare Hospice, Inc. strengthen its policies and procedures to ensure that hospice services comply with Medicare requirements.

HHS should continue to work with OMB and other stakeholders to develop and implement an approach to reporting on CDC and OHS Disaster Relief improper payments in FY 2021

HHS should continue to work with OMB and other stakeholders, including considering recommendations from recent OIG audits, to develop and implement an approach to reporting on APTC improper payments in FY 2021

HHS should continue to explore a vehicle to conduct recovery audits that will fit into the larger Medicare Part C program in FY 2021

HHS should continue to follow up with States during the interim period to verify that corrective actions identified after the improper payment error rate measurement review for the Medicaid and CHIP programs are being implemented. NOTE: The current COVID-19 public health emergency may impact the ability of States to analyze and follow up on corrective action plans. Consequently, this will impact the information reported to CMS.

HHS should focus on the root causes of the improper payment percentage and evaluate critical and feasible action steps to assist States with their compliance efforts for new requirements of the Medicaid and CHIP programs

HHS should continue to work with the Office of Management and Budget and other stakeholders to develop and implement an approach to reporting on Temporary Assistance for Needy Families (TANF) improper payments in FY 2021, which will aid in identifying root causes of TANF improper payments and allow HHS to develop and report corrective action plans

Provide guidance identifying programs and/or activities as a part of its internal guidance and in accordance with achieving its mission requirements.

Align programs and/or activities with applicable reporting requirements.

Report programs and/or activities in accordance with applicable Federal criteria.

Provide training to CPSC program managers on how to develop and implement a formal internal controls program in accordance with Standards for Internal Control in the Federal Government, OMB Circular A-123, and CPSC policies and procedures.

Develop a formal internal controls program over operations for CPSC programs.

Establish formal lines of communication between the Office of Financial Management, Planning and Evaluation and CPSC program management for the purpose of assessing and monitoring internal control programs and compliance with FMFIA requirements.

We recommend that the New York State Department of Health refund $9,325,338 to the Federal Government

We recommend that the New York State Department of Health identify and recover improper managed care payments made to the same MCO on behalf of beneficiaries with more than one Medicaid ID number prior to and after our audit period, and repay the Federal share of the amounts recovered

We recommend that the New York State Department of Health ensure that improvements made to its processes for determining whether an individual applying for Medicaid has already been assigned a Medicaid ID number are effective by verifying that: - system queries are adequate to identify all individuals with existing Medicaid ID numbers and - local district and Marketplace staff are following guidance on identifying individuals with Medicaid ID numbers and using all available resources to identify and prevent the issuance of more than one Medicaid ID number to the same individual.

We recommend that the Centers for Medicare & Medicaid Services direct the Medicare contractors to educate providers on the billing of direct LDL tests in addition to lipid panels (e.g., by providing guidance about the requirements for separately billing direct LDL tests).

We recommend that Suncoast Hospice refund to the Federal Government the portion of the estimated $47,363,971 for hospice services that did not comply with Medicare requirements and that are within the 4-year claims reopening period.

We recommend that Suncoast Hospice strengthen its policies and procedures to ensure that hospice services comply with Medicare requirements.

[Description omitted; CSOSA has determined that this recommendation contains information that is limited official use or classified.]

[Description omitted; CSOSA has determined that this recommendation contains information that is limited official use or classified.]

[Description omitted; CSOSA has determined that this recommendation contains information that is limited official use or classified.]

Conduct new residual risk reviews for Group I polymers and resins that cover neoprene production, synthetic organic chemical manufacturing industry, polyether polyols production, commercial sterilizers, and hospital sterilizers using the new risk values for chloroprene and ethylene oxide and revise the corresponding National Emission Standards for Hazardous Air Pollutants, as needed.

Revise National Emission Standards for Hazardous Air Pollutants for chemical manufacturing area sources to regulate ethylene oxide and conduct a residual risk review to ensure that the public is not exposed to unacceptable risks.

Conduct overdue technology reviews for Group I polymers and resins that cover neoprene production, synthetic organic chemical manufacturing industry, commercial sterilizers, hospital sterilizers, and chemical manufacturing area sources, which are required to be completed at least every eight years by the Clean Air Act.

develop new procedures or enhance current ones to identify beneficiaries with concurrent eligibility in another State, which could have saved the State agency an estimated $1,100,008 ($665,440 Federal share) in capitation payments for the month of August 2018

ensure that county caseworkers follow procedures to timely review and terminate eligibility for beneficiaries who were identified as concurrently eligible in another State.

We recommend that SAMHSA mitigate its Governance risk by formally documenting its full organizational structure.

We recommend that Virtua Our Lady of Lourdes Hospital based on the results of this audit, 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.

CMS should take additional steps to validate the information reported in MDS assessments

CMS should supplement the data it uses to monitor the use of antipsychotic drugs in nursing homes.

We recommend the Secretary, in coordination with DHS components and FPS, establish and implement a plan, policy, and process toimprove preparedness for multi-component response to future incidents of civil disturbance at Federal facilities, including:A. a process for designating DHS component personnel under 40 U.S.C. §1315 and verification of required legal training completion;B. equipment and training needs and requirements; andC. consistent tactics and operational policies.

We recommend that the IA coordinate with Pine Hill School to ensure that the general facility deficiencies noted in this report are either addressed or included as part of the consolidation and renovation of the school facilities (Phase II).

We recommend that the IA coordinate with Pine Hill School to complete the planned consolidation and renovation (Phase II).

We recommend that the IA coordinate with Pine Hill School to complete the gymnasium replacement project (Phase III).

Clarify officer safety-related training requirements for operational personnel, including Task Force Officers, and ensure that the requirements are clearly established in policy.

Ensure that all Tactical Training Officers receive skills sustainment training.

Ensure that the new After-Action Review policy is implemented so that all critical incidents stemming from operations led by and/or involving U.S. Marshals Service personnel are reviewed for lessons learned and used to update and adjust officer safety-related training.

Evaluate whether modifications to training are needed to adequately cover open space encounters and to better support small teams, and, if so, develop and implement methods to ensure that training adequately addresses these.

Update and implement EXRM directives, policies, and procedures regarding position designation to reflect current EXRM operations and address current OPM policies and guidelines.

Develop and maintain an accessible database with all information required to effectively manage the position designation and suitability program. At a minimum, this system should contain the name of the employee or contractor, position number and title, position designation, tier of background investigation completed, entry-on-duty date, date the background investigation was requested, date the background investigation was completed, whether it was an initial investigation or reinvestigation, whether reciprocity was applied, and reinvestigation due date.

Use the information developed in Recommendation Two to track an employee’s investigation versus the designation of their position and ensure they are properly aligned.

Use an automated tool to track when employee and contractor reinvestigations are due.