Open Recommendations

Once the new guidance is developed, train all managers on the new guidance and controls for drop-in meetings and related interactions with external stakeholders.

Refund to the Federal Government $14,281,626 (Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement

Refund to the Federal Government $241,533 (Federal share) for claims for top-20 multiple-source physician-administered drugs that were ineligible for Federal reimbursement

Work with CMS to determine the unallowable portion of $1,328,195 (Federal share) for other claims for multiple-source physician-administered drugs that may have been ineligible for Federal reimbursement, refund that amount, and consider invoicing drug manufacturers for rebates for these drugs if CMS determines that the drug claims are allowable

Work with CMS to determine and refund the unallowable portion of Federal reimbursement for physician-administered drugs that were not invoiced for rebates after December 31, 2019

Continue to review and strengthen its internal controls to ensure that all physician-administered drugs eligible for rebates are invoiced

Rec. 2.a: The DoD OIG recommended that the Under Secretary of Defense for Intelligence and Security update DoD Directive 5210.56, or other appropriate DoD policy, to standardize active shooter incident response procedures and planning, equipment, and training requirements for all Department and Service law enforcement organizations.

Rec. 2.c: The DoD OIG recommended that the Under Secretary of Defense for Intelligence and Security update DoD Directive 5210.56, or other appropriate DoD policy, to identify the roles, responsibilities, and actions to be taken by armed non-first responder law enforcement organization personnel during active shooter incidents.

Rec. 2.d: The DoD OIG recommended that the Under Secretary of Defense for Intelligence and Security update DoD Directive 5210.56, or other appropriate DoD policy, to require installation active shooter incident response plans to include the roles and responsibilities of armed non-first responder law enforcement organization personnel, such as the Defense Criminal Investigative Organization personnel.

Rec. 2.e: The DoD OIG recommended that the Under Secretary of Defense for Intelligence and Security update DoD Directive 5210.56, or other appropriate DoD policy, to require installation commanders at all military installations initiate, update, validate, and exercise installation support agreements with local law enforcement organizations for the joint response to active shooter incidents on military installations.

Rec. 2.f: The DoD OIG recommended that the Under Secretary of Defense for Intelligence and Security update DoD Directive 5210.56, or other appropriate DoD policy, to require Defense Criminal Investigative Organization personnel participation in active shooter incident response exercises using scenarios where the armed non-first responder law enforcement organization personnel are already at the scene of an active shooter incident.

Rec. 2.g: The DoD OIG recommended that the Under Secretary of Defense for Intelligence and Security update DoD Directive 5210.56, or other appropriate DoD policy, to require installation armed non-first responder law enforcement organization personnel, such as the Defense Criminal Investigative Organization field offices, to develop memorandums of understanding with installation law enforcement organizations, which describe the role and responsibilities of Defense Criminal Investigative Organization personnel during an active shooter incident response.

Rec. 2.h: The DoD OIG recommended that the Under Secretary of Defense for Intelligence and Security update DoD Directive 5210.56, or other appropriate DoD policy, to require law enforcement active shooter incident response training be provided to Defense Criminal Investigative Organization personnel.

We recommend the Office of Strategy, Policy, and Plans develop a unified strategy to improve DHS’ coordinated actions among the components and with other agencies to counter disinformation campaigns that appear in social media.

CMS should encourage Part D plans to increase access to and use of the authorized generic versions of Epclusa and Harvoni, within the authorities granted under statute.

CMS should pursue additional strategies—such as educating providers and pharmacies—to increase access to and use of lower-cost hepatitis C drugs in Medicare Part D.

Evaluate efficiency at the 10 facilities to identify inefficiencies in the mail flow (e.g., facility layout/location, space constraints, customer and service impacts, and equipment relocation costs) and, based on the results, consider properly aligning the impacted facilities to efficiently meet the challenges they face based on changes in market demand.

Implement an internal control that prevents a future pension entitlement date on the MBR of more than 1 year in the future.

Identify and correct the future pension entitlement dates on the MBR for the estimated 5,434 beneficiaries who have entitlement dates that do not comply with policy or are not recorded on the MBR.

OIG recommends that until all 11 recommendations (see Appendix A for a list of the 11 recommendations) addressed to the Bureau of Near Eastern Affairs (NEA) referenced in this report (AUD-AOQC-22-33) are implemented and closed, the Under Secretary for Political Affairs monitor NEA's compliance responses to OIG and verify, at least quarterly, that the responses (a) are provided to OIG within the established due dates and (b) contain complete and accurate status updates that include either evidence of implementation or detailed corrective action plans with actual or proposed target dates for achieving these actions.

Recommendation 1:We recommend the Assistant Administrator for Strategic Infrastructure:1. Conduct cyclical reviews (no less than once every 5 years) of the Ames lease process to ensure compliance with federal and NASA requirements.

Recommendation 2:We recommend the Assistant Administrator for Strategic Infrastructure in coordination with the Chief Financial Officer: Update applicable real estate policies and NASA-wide guidance to enhance requirements and procedures to comply with EUL authority and to require maintaining appropriate documentation, documenting decisions, and fostering transparent coordination and communication with internal and external stakeholders in a timely manner.

Recommendation 3: We recommend the Assistant Administrator for Strategic Infrastructure in coordination with the Chief Financial Officer: Update applicable real estate policies and NASA-wide guidance to enhance requirements and standardize applicable financial practices (such as the benefit and cost analysis, life-cycle cost analysis, and audits of tenants’ books and records when required) associated with leases.

Recommendation 5: We recommend the Ames Center Director: Implement written procedures in the lease process to ensure compliance with federal and NASA requirements applicable, but not limited to, timely involvement of the RPAO, competition, life-cycle cost analysis, fair market value assessments, certifications, and termination clauses as appropriate.

Recommendation 4: The Assistant Administrator for Strategic Infrastructure in coordination with the Assistant Administrator for Protective Services: Update applicable real estate policies and NASA-wide guidance to incorporate applicable security requirements and agreement clauses in leases.