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As of May 8, 2024, there are 5108 open recommendations that still need to be addressed. 412 of these are priority recommendations, those that we believe warrant priority attention. Learn more about our priority designation on our Recommendations page.

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4961 - 4980 of 5108 Recommendations, including 412 Priority Recommendations

Medicare: Action Needed to Address Higher Use of Anatomic Pathology Services by Providers Who Self-Refer

GAO-13-445
James Cosgrove
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3 Open Recommendations
Agency Recommendation Status
Centers for Medicare & Medicaid Services In order to improve CMS's ability to identify self-referred anatomic pathology services and help CMS avoid unnecessary increases in these services, the Administrator of CMS should determine and implement an approach to ensure the appropriateness of biopsy procedures performed by self-referring providers.
Open

In June 2013, we recommended that the Administrator of the Centers for Medicare & Medicaid Services (CMS) implement an approach to ensure the appropriateness of biopsy procedures performed by self-referring providers. The Department of Health and Human Services (HHS) did not concur with this recommendation and does not believe it would address overutilization that occurs as a result of self-referral. In November 2017, CMS officials noted that the agency does not have the ability to identify self-referred anatomic pathology services during medical reviews. As of March 2023, CMS has not provided
Centers for Medicare & Medicaid Services In order to improve CMS's ability to identify self-referred anatomic pathology services and help CMS avoid unnecessary increases in these services, the Administrator of CMS should develop and implement a payment approach for anatomic pathology services that would limit the financial incentives associated with referring a higher number of specimens--or anatomic pathology services--per biopsy procedure.
Open

In June 2013, we recommended that the Administrator of the Centers for Medicare & Medicaid Services (CMS) develop and implement a payment approach for anatomic pathology services under the Physician Fee Schedule that would limit the financial incentives associated with referring a higher number of specimens--anatomic pathology services--per biopsy procedure. Although health care providers have discretion in determining the number of tissue samples from biopsy procedures that become specimens (anatomic pathology services), CMS's current payment system under the Physician Fee Schedule provides a
Centers for Medicare & Medicaid Services In order to improve CMS's ability to identify self-referred anatomic pathology services and help CMS avoid unnecessary increases in these services, the Administrator of CMS should insert a self-referral flag on Medicare Part B claim forms and require providers to indicate whether the anatomic pathology services for which the provider bills Medicare are self-referred or not.
Open

In June 2013, we recommended that the Administrator of the Centers for Medicare & Medicaid Services (CMS) insert a self-referral flag on Medicare Part B claim forms and require providers to indicate whether the anatomic pathology services for which the provider bills Medicare are self-referred or not. The Department of Health and Human Services (HHS) did not concur with this recommendation, noting that CMS does not believe that this recommendation will address overutilization that occurs as a result of self-referral. Although CMS has taken initial steps relevant to self-referral, the steps do

Managing for Results: Leading Practices Should Guide the Continued Development of Performance.gov

GAO-13-517
J. Christopher Mihm
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1 Open Recommendations
Agency Recommendation Status
Office of Management and Budget To enhance the value of Performance.gov for intended audiences and improve the ability to identify and prioritize potential improvements, the Director of the Office of Management and Budget--working with the Performance Improvement Council and the General Services Administration--should seek to ensure that all performance, search, and customer satisfaction metrics, consistent with leading practices outlined in HowTo.gov, are tracked for the website, and, where appropriate, create goals for those metrics to help identify and prioritize potential improvements to Performance.gov.
Open

As of July 2023, the Office of Management and Budget (OMB) and General Services Administration (GSA) had taken some actions toward addressing this recommendation. According to information that OMB staff provided in April 2021, OMB and GSA are tracking 15 out of 24 metrics for Performance.gov that are recommended for federal websites, and they are working to collect information related to the remaining 9 metrics. In addition, in March 2021 they began using a Google Analytics account. OMB staff told us in April 2021 that the features and information available through that account should allow

Medicare Imaging Accreditation: Establishing Minimum National Standards and an Oversight Framework Would Help Ensure Quality and Safety of Advanced Diagnostic Imaging Services

GAO-13-246
James Cosgrove
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2 Open Recommendations
Agency Recommendation Status
Centers for Medicare & Medicaid Services To help ensure that ADI suppliers provide consistent, safe, and high-quality imaging to Medicare beneficiaries, the Administrator of CMS should determine the content of and publish minimum national standards for the accreditation of ADI suppliers, which could include specific qualifications for supplier personnel and requiring accrediting organization review of clinical images.
Open

CMS concurred with this recommendation. However, as of September 2022, CMS has not established health and safety standards for the accreditation of ADI suppliers. Until CMS establishes minimum national standards for the accreditation of ADI supplies, it cannot ensure that ADI suppliers provide consistent, safe, and high-quality imaging to Medicare beneficiaries.
Centers for Medicare & Medicaid Services To help ensure that ADI suppliers provide consistent, safe, and high-quality imaging to Medicare beneficiaries, the Administrator of CMS should develop more specific requirements for accrediting organization mid-cycle audit procedures and clarify guidance on immediate-jeopardy deficiencies to ensure consistent identification and timely correction of serious care problems for the duration of accreditation.
Open

CMS concurred with this recommendation but, as of September 2022, had not developed more specific requirements for accrediting organization mid-cycle audit procedures or clarified its guidance on immediate jeopardy deficiencies. CMS provided GAO with internal documentation on immediate jeopardy deficiencies, including reporting templates for accrediting organization to report immediate jeopardy deficiencies to CMS. However, the documentation provided did not include clarifying guidance on what constitutes an immediate-jeopardy deficiency beyond its definition in regulation. Until CMS

DOD Business Systems Modernization: Further Actions Needed to Address Challenges and Improve Accountability

GAO-13-557
Valerie C. Melvin
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3 Open Recommendations
Agency Recommendation Status
Department of Defense To effectively implement key components of DOD's business systems modernization program, the Secretary of Defense should direct the Deputy Chief Management Officer to ensure that the functional strategies include all of the critical elements identified in DOD investment management guidance, including performance measures to determine progress toward achieving the goals that incorporate all of the attributes called for in the department's guidance.
Open

As of September 2023, the Department of Defense (DOD) has not addressed this recommendation. Specifically, in September 2023, DOD stated that it plans to issue revised investment management guidance that will require defense business systems to align to DOD requirements and associated performance measures. The department added that its revised investment management guidance may not include a requirement for functional strategies. Further, the department stated that it plans to publish its business systems investment management guidance in June 2024. We will continue to monitor the department's
Department of Defense To effectively implement key components of DOD's business systems modernization program, the Secretary of Defense should direct the Deputy Chief Management Officer to select and control its mix of investments in a manner that best supports mission needs by (a) documenting a process for evaluating portfolio performance that includes the use of actual versus expected performance data and predetermined thresholds; (b) ensuring that portfolio assessments are conducted in key areas identified in our IT investment management framework: benefits attained; current schedule; accuracy of project reporting; and risks that have been mitigated, eliminated, or accepted to date; and (c) ensuring that the documents provided to the Defense Business Council as part of the investment management process include critical information for conducting all assessments.
Open

As of September 2023, the Department of Defense (DOD) has not addressed the recommendation. Specifically, in September 2023, the department stated that it plans to issue revised investment management guidance that will contain requirements, procedures, and criteria to enable the DOD Chief Information Officer to more effectively manage the department's portfolio of defense business systems. Further, the department stated that it plans to publish its business systems investment management guidance in June 2024. We will continue to monitor the department's efforts to fully implement this
Department of Defense To effectively implement key components of DOD's business systems modernization program, the Secretary of Defense should direct the Deputy Chief Management Officer to define by when and how the department plans to develop an architecture that would extend to all defense components and include, among other things, (a) information about the specific business systems that support business enterprise architecture (BEA) business activities and related system functions; (b) business capabilities for the Hire-to-Retire and Procure-to-Pay business processes; and (c) sufficient information about business activities to allow for more effective identification of potential overlap and duplication.
Open

As of September 2023, the Department of Defense (DOD) has not addressed this recommendation. In September 2023, DOD stated that DOD's Chief Information Officer is creating a federated, questions-based, data-centric DOD business enterprise architecture (BEA) to address CIO rationalization priorities and functional areas business questions. According to the department, it plans to publish a DOD BEA framework and guidebook to describe its BEA modernization approach by June 2024. We will continue to monitor the department's efforts to fully implement this recommendation.

Management Report: Improvements Are Needed to Enhance the Internal Revenue Service's Internal Controls

GAO-13-420R
Cheryl E. Clark
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2 Open Recommendations
Agency Recommendation Status
Internal Revenue Service The Acting Commissioner of Internal Revenue should direct the appropriate IRS officials to, based on the results of the risk assessment, update the Internal Revenue Manual (IRM) accordingly to specify the appropriate level of IDRS access that should be allowed for (1) remittance perfection technicians and (2) all other employee groups with IDRS access that handle hard-copy taxpayer receipts and related sensitive information as part of their job responsibilities.
Open

During fiscal year 2021, the SB/SE and TE/GE organizations updated applicable IRM sections to include policy changes on risk mitigation, including specifying the appropriate level of IDRS access allowed for employee groups who handle hard-copy taxpayer receipts and related sensitive information. During fiscal year 2022, IRS officials told us that the TAS organization will address this recommendation in the future. As a result, this recommendation remains open as of September 30, 2022.
Internal Revenue Service The Acting Commissioner of Internal Revenue should direct the appropriate IRS officials to establish procedures to implement the updated IRM, including required steps to follow to prevent (1) remittance perfection technicians and (2) all other employee groups that handle hard-copy taxpayer receipts and related sensitive information as part of their job responsibilities from gaining access to command codes not required as part of their designated job duties.
Open

During fiscal year 2021, the SB/SE and TE/GE organizations established procedures in the applicable IRM sections to prevent employee groups who handle hard-copy taxpayer receipts and related sensitive information from gaining access to command codes not required as part of their designated job duties. During fiscal year 2022, IRS officials told us that the TAS organization will address this recommendation in the future. As a result, this recommendation remains open as of September 30, 2022.

DOD Financial Management: Significant Improvements Needed in Efforts to Address Improper Payment Requirements

GAO-13-227
Asif A. Khan
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Department of Defense
Priority Rec.
The Secretary of Defense should direct the Under Secretary of Defense (Comptroller), with regard to estimating improper payments, to establish and implement key quality assurance procedures, such as reconciliations, to ensure the completeness and accuracy of the sampled populations.
Open

DOD agreed with this recommendation. The Office of the Under Secretary of Defense (Comptroller) developed an inventory of approximately 80 DOD systems related to disbursing functions. As of March 2024, DOD estimated that by May 2025, the Defense Finance and Accounting Service and DOD components will have established financial management system agreements for improper payments testing. These signed agreements will require DOD components to affirm the completeness of the payments in each financial management system to ensure the completeness and accuracy of the sampled populations. In addition

Missile Defense: Opportunity to Refocus on Strengthening Acquisition Management

GAO-13-432
Cristina T. Chaplain
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2 Open Recommendations
2 Priority
Agency Recommendation Status
Department of Defense
Priority Rec.
In order to strengthen investment decisions, place the chosen investments on a sound acquisition footing, provide a better means of tracking investment progress, and improve the management and transparency of the U.S. missile defense approach in Europe, the Secretary of Defense should direct MDA's new Director to include in its resource baseline cost estimates all life cycle costs, specifically the operations and support costs, from the military services in order to provide decision makers with the full costs of ballistic missile defense systems.
Open – Partially Addressed

DOD agreed that decisionmakers should have insight into the full lifecycle costs of the Missile Defense Systems programs but disagreed with MDA's responsibility to account for the military services' portion of the operations and sustainment costs for such programs. In 2020, DOD requested that we close this recommendation as implemented, citing MDA's preparation of joint cost estimates (JCE) with the military services to capture their respective operations and sustainment costs. However, in February 2022, we found that not all applicable programs have a JCE as required by policy and the
Department of Defense
Priority Rec.
In order to strengthen investment decisions, place the chosen investments on a sound acquisition footing, provide a better means of tracking investment progress, and improve the management and transparency of the U.S. missile defense approach in Europe, the Secretary of Defense should direct MDA's new Director to stabilize the acquisition baselines, so that meaningful comparisons can be made over time that support oversight of those acquisitions.
Open – Partially Addressed

DOD agreed with our recommendation but noted that MDA has the authority to adjust program baselines to remain responsive to evolving requirements and threats. We acknowledged MDA's authority to adjust program baselines and explained that our recommendation did not intend to limit such authority, but rather address issues we found, such as shifting content and costs between baselines without clear traceability. In 2020, DOD requested that we close this recommendation as implemented based on MDA's addition of a list of significant changes to its annual baseline reporting. MDA officials said that

Managing For Results: Agencies Should More Fully Develop Priority Goals under the GPRA Modernization Act

GAO-13-174
J. Christopher Mihm
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2 Open Recommendations
Agency Recommendation Status
Office of Management and Budget When such revisions are made, the Director of OMB should work with the Performance Improvement Council to test and implement these provisions.
Open

As of July 2023, OMB has not taken action to address this recommendation. According to information provided by OMB and PIC staff in June 2015, although OMB revised its guidance as we recommended, it did not work with the PIC to test implementation of these provisions. Instead, they told us that both PIC and OMB staff ensure agencies are implementing these provisions of their guidance when reviewing agency priority goal (APG) quarterly update submissions. However, our periodic analyses of agencies' APG updates since that time, including updates from June 2022, has continued to find that
Office of Management and Budget In addition, as OMB works with agencies to enhance Performance.gov to include additional information about APGs, the Director of OMB should ensure that agencies adhere to OMB's guidance for website updates by providing a description of how input from congressional consultations was incorporated into each APG.
Open

As of July 2023, OMB has taken limited actions to address this recommendation. In July 2017, OMB staff said that they planned on highlighting the requirement for congressional consultation as they updated the 2018-2019 agency priority goals (APG). However, the reporting templates for individual APGs at that time did not contain space to provide this information. In its July 2020 guidance, OMB directed agencies to highlight congressional input, if such input was relevant to setting a specific goal, in the APG overview section of the template. Our periodic analysis of APG updates, including

IRS Website: Long-Term Strategy Needed to Improve Interactive Services

GAO-13-435
James (Jay) R. McTigue, Jr
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1 Open Recommendations
Agency Recommendation Status
Internal Revenue Service The Acting Commissioner of the Internal Revenue Service should direct appropriate officials to develop a long-term strategy to improve web services provided to taxpayers, in accordance with Howto.gov and other federal guidance outlined in our report. To accomplish this, the IRS should establish a numerical or other measureable goal to improve taxpayer satisfaction and a timeframe for achieving it.
Open

IRS has made progress in improving its online services strategy, as we recommended, but as of March 2024, IRS has not yet completed its efforts. IRS's Office of Online Services reported that it is working to establish a plan to develop a suite of customer satisfaction metrics, goals for those metrics and a regular reporting structure. According to officials, IRS will track measures such as satisfaction, trust, effectiveness, ease and efficiency, to align with the Office of Management and Budget's A-11 requirements. IRS plans to establish a baseline for these measures in April 2024, which will

Climate Change: Future Federal Adaptation Efforts Could Better Support Local Infrastructure Decision Makers

GAO-13-242
David Trimble
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2 Open Recommendations
2 Priority
Agency Recommendation Status
U.S. Global Change Research Program
Priority Rec.
To improve the resilience of the nation's infrastructure to climate change, the Executive Director of the United States Global Change Research Program or other federal entity designated by the Executive Office of the President should work with relevant agencies to identify for decision makers the "best available" climate-related information for infrastructure planning and update this information over time.
Open – Partially Addressed

As of January 2023, according to officials from the Office of Science and Technology Policy (OSTP), the U.S. Global Change Research Program (USGCRP) is developing a Climate Resilience Information System (CRIS) that will provide access to the "best available" climate-related information. OSTP, in coordination with USGCRP and NOAA, released the Climate Mapping for Resilience Assessments (CMRA) portal in September 2022. CMRA is an example of the type of information resource that CRIS will more efficiently enable, once fully established. In addition, On March 22, 2023, OSTP released a report
U.S. Global Change Research Program
Priority Rec.
To improve the resilience of the nation's infrastructure to climate change, the Executive Director of the United States Global Change Research Program or other federal entity designated by the Executive Office of the President should work with relevant agencies to clarify sources of local assistance for incorporating climate-related information and analysis into infrastructure planning, and communicate how such assistance will be provided over time.
Open – Partially Addressed

In January 2023, officials from the Office of Science and Technology Policy (OSTP) noted that regional science organizations, such as the National Oceanic and Atmospheric Administration's Climate Action Partnerships, work to provide climate information to regional and local agencies. These officials also said that the United States Global Change Research Program (USGCRP) continues work on the development of the Climate Resilience Information System (CRIS), which will allow for more efficient development of regionally- and locally-tailored resources. They further stated that the evolving

Federal Employees' Compensation Act: Case Examples Illustrate Vulnerabilities That Could Result in Improper Payments or Overlapping Benefits

GAO-13-386
Seto J. Bagdoyan
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1 Open Recommendations
Agency Recommendation Status
Congress Congress should consider granting Labor the additional authority it is seeking to access wage data to help verify claimants' reported income and help ensure the proper payment of benefits.
Open

No legislation introduced as of February 2024. The Workers' Compensation Reform Act of 2015 (S. 2051, title V) was introduced in the 114th Congress. It would have allowed DOL to access wage data, as GAO suggested in April 2013, from the National Directory of New Hires to improve the integrity of the Federal Employees' Compensation Act program, among other actions. If similar legislation were introduced in the 118th Congress and enacted, this legislation could help to prevent and detect improper payments in the Federal Employees' Compensation Act program.
Note: the list of open recommendations for the last report may continue on the next page.

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