Open Recommendations

The OIG recommended the under secretary for health, in conjunction with the chief acquisition officer and principal executive director for the Office of Acquisition, Logistics, and Construction, ensure the Office of Integrated Veteran Care and the Office of Acquisition, Logistics, and Construction, collaborate to extend the contracting officers representatives designated responsibilities to include monitoring of healthcare invoices.

The OIG recommended the under secretary for health make sure the Office of Integrated Veteran Care considers including dental contract reimbursement language in the current and/or future contracts that is consistent with other contract healthcare reimbursement methodology to limit dental contract reimbursements, not to exceed the amount the third-party administrators pay the providers.

The OIG recommended the chief acquisition officer and principal executive director for the Office of Acquisition, Logistics, and Construction make certain the Office of Procurement, Acquisition, and Logistics develops sufficient oversight and internal controls over the contract modification process to prevent program overpayments.

The OIG recommended the under secretary for health, in conjunction with the chief acquisition officer and principal executive director for the Office of Acquisition, Logistics, and Construction, require the Office of Veteran Integrated Care and the Office of Acquisition, Logistics, and Construction to collaborate to explore potential recovery of dental payments to Optum.

The OIG recommended the under secretary for health, in conjunction with the chief acquisition officer and principal executive director for the Office of Acquisition, Logistics, and
Construction, ensure the Office of Integrated Veteran Care and the Office of Acquisition, Logistics, and Construction collaborate to establish oversight and internal controls for dental services provided through Community Care Network to prevent excessive reimbursements.

We recommend that USAID/Kenya and East Africa determine the allowability of $167,463 in ineligible questioned costs on page 28 of the audit report and recover any amount that is unallowable.

We recommend that USAID/Kenya and East Africa verify that Mission for Essential Drugs and Supplies corrects the one material weakness in internal control detailed on page 32 of the audit report.

We recommend that USAID/Kenya and East Africa verify that Mission for Essential Drugs and Supplies corrects the four instances of material noncompliance detailed on pages 34 to 39 of the audit report.

We recommend that USAID/Southern Africa determine the allowability of $112,456 in questioned costs ($104,385 ineligible, $8,071 unsupported) on pages 15 and 21 of the audit report and recover any amount that is unallowable.

We recommend that USAID/Southern Africa verify that Young Heroes corrects the three material weaknesses in internal control detailed on pages 24 to 27 of the audit report.

CMS should Assist MACs in obtaining more complete and timely utilization data with which to make coverage determinations.

CMS should Provide guidance on how MACs should account for enrollees who receive injections in both home and professional settings when performing their comparisons.

We recommend the Assistant Secretary for the Employee Benefits Security Administration pursue legislative changes regarding the authority to impose civil monetary penalties for Mental Health Parity Addiction and Equity Act violations to increase compliance with Part 7 of ERISA, which include the mental health parity provisions.

We recommend the Assistant Secretary for the Employee Benefits Security Administration pursue legislative changes regarding the authority to enforce the group health plan requirements of Part 7 of ERISA against service providers, including insurance issuers and third-party administrators for violations such as designing and applying impermissible non-quantitative treatment limitations.

We recommend the Assistant Secretary for the Employee Benefits Security Administration pursue legislative changes regarding provisions that specify remedies available for violations of Part 7 of ERISA, including the ability to force the re-adjudication of wrongfully denied claims or other remedies to restore losses resulting from Mental Health Parity and Addiction Equity Act violations.

We recommend the Assistant Secretary for the Employee Benefits Security Administration develop processes to utilize enforcement tools available to the agency, including referring health plans to the U.S. Department of the Treasury to levy the excise tax for Mental Health Parity and Addiction Equity Act violations, as appropriate.

We recommend the Assistant Secretary for the Employee Benefits Security Administration develop and issue additional guidance to support the implementation of the 2021 Consolidated Appropriations Act non-quantitative treatment limitation comparative analysis requirements and the September 2024 Mental Health Parity and Addiction Equity Act final rule, such as an updated Mental Health Parity and Addiction Equity Act Self-Compliance Tool or Frequently Asked Questions document(s).

In our February 2024 alert, we recommended that the Director, Field Assistance, take actions to address the issues we identified regarding the hours of operation, incorrect addresses, and current operational status to ensure that taxpayers have the most accurate and up-to-date information available. Additionally, immediate action should be taken to ensure that TAC facilities that are open for extended hours are accessible to taxpayers and that the hours posted at the facility are accurate and observed.

The Chief, Taxpayer Services, should develop processes and procedures to ensure that the hours of operation are accurately posted at all TAC locations and consistent with what is reflected on the IRS website. These processes and procedures should include verification steps to be taken as part of the IRS’s annual filing season readiness confirmation process.

In our February 2024 alert, we recommended that the Director, Field Assistance, and Chief, Facility Management and Security Services, take action to address the issues identified regarding the lack of security measures to ensure that taxpayers are being provided appropriate taxpayer services, and protect IRS employees and taxpayers when visiting the TACs. Additionally, processes should be implemented to ensure that all security guards are aware of their responsibilities when interacting with taxpayers to include mandatory security screening policies and refraining from impeding a taxpayer’s ability to speak with IRS employees.

The Chief, Taxpayer Services, should develop processes and procedures to ensure that services offered at the TACs, including those to be provided to taxpayers without an appointment, are consistent and in conformance with internal guideline requirements. These processes and procedures should include verification steps to be taken as part of the IRS’s annual filing season readiness confirmation processes.

The Chief, Taxpayer Services, should perform a cost-benefit analysis to ensure a business need, including a benefit to the taxpaying public, continues to exist in providing local TAC telephone lines.

The Chief, Taxpayer Services, should develop processes and procedures to ensure the accuracy and consistency of recorded messages while local telephone lines continue to be in place. These processes and procedures should include verification steps to be taken as part of the IRS’s annual filing season readiness confirmation processes.

We recommend that USAID/West Africa determine the allowability of $39,329 in unsupported costs on pages 11, 12 to 14 of the audit report and recover any amount that is unallowable.

We recommend that USAID/West Africa verify that National Episcopal Conference in Cameroon corrects the four material weaknesses in internal control detailed on pages 17 to 21 of the audit report.

We recommend that USAID/West Africa verify that National Episcopal Conference in Cameroon corrects the two instances of material noncompliance detailed on pages 21 and 22 of the audit report.

We recommend that USAID/Southern Africa determine the allowability of $25,847 in ineligible questioned costs on page 20 of the audit report and recover any amount that is unallowable.

We recommend that the Mental Health Center of Florida monitor and evaluate the effectiveness of the QA program updates to ensure that documenting of time spent on psychotherapy services meets Medicare requirements.

We recommend that the Mental Health Center of Florida monitor and evaluate the effectiveness of the QA program updates to ensure that documenting of time spent on psychotherapy services meets Medicare requirements.

We recommend that the Massachusetts Executive Office of Health and Human Services recover from IMDs and CBDCs $21,606,437 in SNCP payments that exceeded the cost of caring for Medicaid and uninsured patients.

We recommend that the Massachusetts Executive Office of Health and Human Services correct its $6,239,386 overstatement of CPEs on the CMS-64, which represents the difference between its CPE estimates and the actual uncompensated care provided to uninsured patients for State-owned hospitals.

We recommend that the Massachusetts Executive Office of Health and Human Services refund to the Federal government the $13,922,912 Federal share of the total $27,845,823 in SNCP expenditures that did not comply with Federal requirements.

We recommend that the Massachusetts Executive Office of Health and Human Services develop and implement policies and procedures that instruct personnel to perform interim and final reconciliations required by the STCs.

We recommend that the Massachusetts Executive Office of Health and Human Services perform reconciliations for the SFYs following our audit period, where the required Medicare cost reports or UFRs are available. In addition, it should refund the Federal share of any oversated CPEs, as well as recover any overpayments to IMDs and CBDCs and refund the Federal share.

We recommend that, for items or services for which the Medicare program establishes a quantity limit, CMS use the results of this audit to research and determine the best method(s) (e.g., nationwide system edits, information-sharing between providers, and other mechanisms) to detect and prevent improper payments to providers.

OIG recommends that OST determine the allowability of the questioned transactions and recover $933,026 if applicable.

OIG recommends that OST work with the Federal Highway Administration to determine the allowability of questioned tribal transactions and recover $5,803,740, if applicable.

OIG recommends that OST work with the Federal Transit Administration to determine the allowability of questioned tribal transactions and recover $136,402, if applicable.

Rec. 1.a: The DoD OIG recommended that the Director, Defense Health Agency, modify the managed care support contracts or TRICARE guidance to explicitly require the TRICARE managed care support contractors to use the Defense Health Agency-established age limits list for all claims.

Rec. 1.b: The DoD OIG recommended that the Director, Defense Health Agency perform a one-time review to ensure that all existing age limits within the Defense Health Agency-established age limits list match age limits established by the American Medical Association and Centers for Medicare and Medicaid Services, where applicable, and revise the age limits accordingly.

Rec. 1.c: The DoD OIG recommended that the Director, Defense Health Agency perform a review of the $1 million in payments that the managed care support contractors paid for health care services provided from FYs 2019 to 2023 that did not meet the Defense Health Agency-established age limits list, and recoup where applicable. As part of the review, assess the managed care support contractors' medical review process when determining whether the managed care support contractors paid for services and items in compliance with the Defense Health Agency-established age limits list.

Rec. 1.d: The DoD OIG recommended that the Director, Defense Health Agency perform a review of the $26.3 million in questioned costs that the managed care support contractors paid for pediatric enteral formula provided from FYs 2019 to 2023 in which the Defense Health Agency-established aged limits list did not meet the pediatric description as defined by the Centers for Medicare and Medicaid Services and age limits identified within product labeling and medical literature. Initiate recoupment of the payments if the Defense Health Agency determines that the managed care support contractors should not have paid for the pediatric enteral formula.

Rec. 1.e: The DoD OIG recommended that the Director, Defense Health Agency revise Defense Health Agency policy to require the Defense Health Agency to perform an annual review of high-risk payments in which managed care support contractors paid claims for health care services and items provided in FY 2024 and future years that did not meet the Defense Health Agency-established age limits list requirements.

Rec. 1.a: The DoD OIG recommended that the Assistant Secretary of the Army (Manpower and Reserve Affairs), in coordination with the Commanding General of the Army Training and Doctrine Command conduct a review to determine how trainees entered the Assessment of Recruit Motivation and Strength 2.0 pilot program above the allowable initial entry body fat composition standards.

Rec. 1.b: The DoD OIG recommended that the Assistant Secretary of the Army (Manpower and Reserve Affairs), in coordination with the Commanding General of the Army Training and Doctrine Command develop and implement procedures to ensure the applicants entering the Assessment of Recruit Motivation and Strength 2.0 pilot program meet the authorized body fat percentages.

Rec. 2.a: The DoD OIG recommended that the Commanding General of the Army Training and Doctrine Command, in coordination with the Commanding General of the Army Training Center and Fort Jackson, review resourcing deficiencies within the medical resources dedicated to the Assessment of Recruit Motivation and Strength 2.0 pilot program to develop and implement a plan to meet the medical service requirements for the program.

Rec. 2.b: The DoD OIG recommended that the Commanding General of the Army Training and Doctrine Command, in coordination with the Commanding General of the Army Training Center and Fort Jackson, review resourcing deficiencies within the medical resources dedicated to the Assessment of Recruit Motivation and Strength 2.0 pilot program to develop and implement a plan to manage the number of Assessment of Recruit Motivation and Strength 2.0 pilot program trainees based on the availability of medical resources.

Establish requirements for complete and current Division approvals of State Department of Transportation (State DOT) construction quality assurance programs.

Implement controls to ensure that all applicable construction quality assurance program documents used on State DOT and locally-administered National Highway System (NHS) projects are approved by Divisions and referenced in Stewardship and Oversight Agreements as required.

Require Divisions to develop and implement written procedures for conducting appropriate oversight of State DOT construction quality assurance programs and addressing the minimum oversight areas as described in FHWA's 2006 policy on construction quality assurance.