Open Recommendations

The Commissioner, Wage and Investment Division, should consider working with its external partners to add retailers in States without a participating location to increase the availability of the payment option

The Commissioner, Wage and Investment Division, should conduct public awareness activities to increase taxpayers’ knowledge of all cash payment options and update internal guidance to reflect the most current information about cash payment options.

We recommend that Opportunities for Williamson and Burnet Counties implement procedures designed to ensure that Federal funds are drawn down only in the amounts needed to meet the immediate cash requirements of its CSBG and LIHEAP-related activities.

We recommend that Opportunities for Williamson and Burnet Counties work with CAS to either be released from the existing indirect cost rate or negotiate a current indirect cost rate for claiming future indirect costs.

We recommend that Opportunities for Williamson and Burnet Counties train employees to follow existing policies and procedures for approval of expenses.

We recommend that Opportunities for Williamson and Burnet Counties instruct and train its finance employees to use the grant year program code built into the accounting software to identify revenues and expenses by specific grant year for all Head Start, CSBG, and LIHEAP general ledger transactions.

We recommend that Opportunities for Williamson and Burnet Counties refund $3,207 in unallowable costs.

We recommend that Opportunities for Williamson and Burnet Counties develop and implement a reasonable basis to allocate meal costs, kitchen salaries, and central office expenses between the Head Start and Senior Nutrition programs in accordance with the benefits received.

Although the Federal marketplace properly determined most individuals’ eligibility for insurance affordability programs, to address the specific deficiencies that we identified, we recommend that the Centers for Medicare & Medicaid Services take steps to ensure that the Federal marketplace corrects an error in its eligibility and enrollment system so that information on whether an individual met the 5 year bar does not automatically carry over from a previous coverage year.

Although the Federal marketplace properly determined most individuals’ eligibility for insurance affordability programs, to address the specific deficiencies that we identified, we recommend that the Centers for Medicare & Medicaid Services take steps to ensure that the Federal marketplace establishes guidance to exclude income from other gains on a Federal tax return submitted by an individual when resolving an income inconsistency.

Although the Federal marketplace properly determined most individuals’ eligibility for insurance affordability programs, to address the specific deficiencies that we identified, we recommend that the Centers for Medicare & Medicaid Services take steps to ensure that the Federal marketplace revises its written guidance so that it does not extend an individual’s inconsistency period when the marketplace receives returned mail.

To improve procedures related to verifying whether individuals complied with the requirement to file a Federal tax return and reconcile APTC payments, we recommend that the Centers for Medicare & Medicaid Services ensure that the Federal marketplace’s eligibility and enrollment system performs subsequent FTR verifications for an individual who received an FTR indicator for a tax-filing extension.

To improve procedures related to verifying whether individuals complied with the requirement to file a Federal tax return and reconcile APTC payments, we recommend that the Centers for Medicare & Medicaid Services require an individual to submit supporting documentation (e.g., a Federal tax return with IRS Form 8962) when he or she attests to having filed a tax return to reconcile a previous year’s APTC payments.

Although the Federal marketplace properly determined most individuals’ eligibility for insurance affordability programs, to address the specific deficiencies that we identified, we recommend that the Centers for Medicare & Medicaid Services take steps to ensure that the Federal marketplace corrects an error in its eligibility and enrollment system so that the system does not incorrectly show that an individual is no longer enrolled in a QHP.

Although the Federal marketplace properly determined most individuals’ eligibility for insurance affordability programs, to address the specific deficiencies that we identified, we recommend that the Centers for Medicare & Medicaid Services redetermine, if necessary, the eligibility of the eight sampled individuals for whom eligibility for insurance affordability programs was not or may not have been determined in accordance with Federal requirements.

Although the Federal marketplace properly determined most individuals’ eligibility for insurance affordability programs, to address the specific deficiencies that we identified, we recommend that the Centers for Medicare & Medicaid Services take steps to ensure that the Federal marketplace implements a change in its eligibility and enrollment system so that the system maintains data showing that verifications of minimum essential coverage through non-ESI were performed, even if responses were not received from some of the electronic data sources.

Although the Federal marketplace properly determined most individuals’ eligibility for insurance affordability programs, to address the specific deficiencies that we identified, we recommend that the Centers for Medicare & Medicaid Services take steps to ensure that the Federal marketplace corrects an error in its eligibility and enrollment system so that the marketplace generates an inconsistency when an individual’s attested information related to eligibility for minimum essential coverage through ESI is not completed.

The Assistant Secretary for Management should ensure that the Office of the Deputy Assistant Secretary for Human Resources and Chief Human Capital Officer (DASHR/CHCO) and the Office of Executive Resources (OER) calculate the overpayment amounts for the two Departmental Office (DO) Senior Executive Service (SES) members whose pay was set higher than allowed by regulation.

We recommend that the New York State Department of Health refund $39,329,059 to the Federal Government.

We recommend that the New York State Department of Health ensure that providers comply with Federal and State requirements for providing and claiming reimbursement for OTP services.

We recommend that the New York State Department of Health implement procedures to detect and prevent duplicate claims for OTP services.

USAID/Zambia determine the allowability of $1,192,504 in questioned costs ($14,127 ineligible, $1,178,377 unsupported) on pages 13 and 16 of the audit report and recover any amount that is unallowable.

USAID/Zambia determine the allowability of $1,063,630 in questioned cost sharing costs contributions ($40,346 ineligible, $1,023,284 unsupported) on page 69 of the audit report and recover any amount that is unallowable.

We recommend that the PBS Commissioner address the specific vulnerabilities the OIG identified for the child care centers.

We recommended that the PBS Commissioner conduct a comprehensive assessment to identify security vulnerabilities at each child care center located in a GSA-controlled building and expedite action to upgrade these buildings to the minimum security standards. If PBS cannot address vulnerabilities identified in these buildings, the child care centers should be moved to safer locations.

Determine the allowability of the questioned transactions and recover $1,135,453, if applicable.

(a) Ensure that OIT monitors and promptly installs patches and antivirus updates across the enterprise when they are available from the vendor. Enhancements should include:Pending since FY 2017. (b) Implement a process to track patching of network devices and servers by the defined risk-based patch timelines in CNCS policy. (c) Monitor and record actions taken by the contractor to ensure vulnerability remediation for network devices and servers is addressed or the exposure to unpatchable vulnerabilities is minimized. (d) Replacement of information system components when support for the components is no longer available from the developer, vendor or manufacturer. (e) Enhance…

Ensure that OIT evaluates if the internet connections at the National Civilian Community Corps Campuses and Regional Offices are sufficient to allow patches to be deployed to all devices within the defined risk-based patch timeline in CNCS policy. If the internet connections are determined to be inadequate, develop and implement a plan to enhance the current internet connections.

Develop and implement a written process to perform periodic reconciliations between CMDB and the FasseTrack system.

Physically or mechanically disable the networking capability of the laptop used for member badging at the NCCC Pacific Region Campus.

Document and implement a process to validate that physical counselor files from the NCCC Southwest Region Campus are disposed of within six years after the date of the member’s graduation in accordance with the AmeriCorps NCCC Manual.

Federal regulations define rehabilitative services as services recommended by a licensed practitioner for maximum reduction of physical or mental disability and restoration of a beneficiary to their best possible functional level. State regulations for PACT, which the State agency defines in its Medicaid State plan as a rehabilitative program, stipulate that the prior authorization of services shall cover all dates that services were provided to ensure proper reimbursement. Although State regulations stipulate that a prior authorization should cover all dates of service, they do not specify a timeframe for which authorized services are eligible for Medicaid reimbursement. Essentially, this results…

Of the 100 sampled State agency claims for Federal Medicaid reimbursement of payments for PACT services, 50 complied with Federal and State requirements, but the remaining 50 did not. The below deficiencies were found and many of the claims had more than one deficiency. *Services not adequately supported or documented *Plan of care requirements not met *Required clinical disciplines not included on PACT team *Prior authorization requirements not met *No documentation of compliance with boarding home requirements *Documentation did not support 2 hours of face-to-face contact *No nursing assessment

Of the 100 sampled State agency claims for Federal Medicaid reimbursement of payments for PACT services, 50 complied with Federal and State requirements, but the remaining 50 did not. The deficiencies occurred because the State agency did not inform PACT providers of all Federal and State requirements for providing PACT services, and its monitoring procedures were not adequate to identify all instances when providers did not claim PACT services in accordance with these requirements. In fact, the monitoring procedures did not include checking whether some requirements were met. As a result, PACT providers did not follow requirements for providing PACT…

Of the 100 sampled, State agency claims for Federal Medicaid reimbursement of payments for PACT services, 50 complied with Federal and State requirements, but the remaining 50 did not. These deficiencies occurred because providers were not aware of all PACT requirements or did not adhere to the requirements.

Review IRDF’s use of prolonged administrative segregation and seek alternative housing when appropriate.

Ensure that, for detainees in administrative segregation, IRDF provides outdoor recreation and access to privileges similar to those offered to detainees in the general population, in compliance with 2011 PBNDS requirements.

Require IRDF staff to complete daily face-to-face medical visits with detainees in administrative segregation to ensure detainee welfare.

Review the IRDF facility conditions we identified as deficient to ensure corrective action in compliance with 2011 PBNDS requirements.

Require IRDF staff to provide written responses to medical grievances and provide copies to the detainees who filed the grievances.

More clearly identify time, duration, and location for facility visits to ensure detainees’ regular access to assigned ICE ERO deportation officers.

We recommend that the Centers for Medicare & Medicaid Services instruct the Medicare contractors to review the $2,263,465 in improper payments for claims with dates of service after the beneficiaries’ dates of death and initiate recoupment for the amounts identified as improper payments.

We recommend that the Centers for Medicare & Medicaid Services instruct the Medicare contractors to review deductible amounts that may have been incorrectly collected from beneficiaries or from someone on their behalf and take appropriate actions to resolve these amounts.

We recommend that Novitas Solutions, Inc. educate providers on how to correctly calculate the prorated mileage for phlebotomy travel allowance payments.

We recommend that Novitas Solutions, Inc. educate providers on their responsibility to bring any previously paid claims to their MAC's attention if they were paid using the wrong rate.

We recommend that Novitas Solutions, Inc. educate providers on their responsibility to maintain adequate documentation to support payment for phlebotomy travel allowance payments.

We recommend that Novitas Solutions, Inc. work with the Centers for Medicare & Medicaid Services to clarify guidance to providers, which could have resulted in savings totaling an estimated $2,373,676 during our audit period.

We recommend that the New York Department of Health refund $614,530 to the Federal Government.