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As of May 9, 2024, there are 5117 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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5041 - 5060 of 5117 Recommendations, including 412 Priority Recommendations

Medicare Advantage: CMS Should Improve the Accuracy of Risk Score Adjustments for Diagnostic Coding Practices

GAO-12-51
James Cosgrove
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Centers for Medicare & Medicaid Services
Priority Rec.
To help ensure appropriate payments to MA plans, the Administrator of CMS should take steps to improve the accuracy of the adjustment made for differences in diagnostic coding practices between MA and Medicare FFS. Such steps could include, for example, accounting for additional beneficiary characteristics, including the most current data available, identifying and accounting for all years of coding differences that could affect the payment year for which an adjustment is made, and incorporating the trend of the impact of coding differences on risk scores.
Open – Partially Addressed

CMS indicated in March 2021 that, given the complexity of measuring coding changes attributable to plan behavior and the difficulty of measuring countervailing factors, there is not a single correct factor within the viable range of adjustment factors. In addition, the agency noted that there is policy discretion with respect to the appropriate adjustment factor for the payment year. CMS applied the statutory minimum adjustment of 5.90 for calendar year 2023. As of February 2024, CMS had not provided any documentation of its analysis and the basis for its determination. Although the

2011 Tax Filing: Processing Gains, but Taxpayer Assistance Could Be Enhanced by More Self-Service Tools

GAO-12-176
James R. White
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1 Open Recommendations
Agency Recommendation Status
Internal Revenue Service The Commissioner of Internal Revenue should develop a new refund timeliness measure and goal to more appropriately reflect current capabilities.
Open

As of April 2024, IRS had not developed a new measure and goal for refund timeliness. During fiscal year 2023, individual taxpayers filed about 91 percent of returns electronically, and as a means to set taxpayer expectations, IRS publicly reported that about 90 percent of taxpayers owed a refund received it in less than 21 days. However, IRS does not set expectations for taxpayers that file on paper or have other situations that could result in longer processing times. In February 2023, IRS provided us with its analysis of refund timeliness that detailed the number of days IRS took to issue

Medicaid: Prototype Formula Would Provide Automatic, Targeted Assistance to States during Economic Downturns

GAO-12-38
Carolyn L. Yocom
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1 Open Recommendations
Agency Recommendation Status
Congress To ensure that federal funding efficiently and effectively responds to the countercyclical nature of the Medicaid program, Congress may wish to consider enacting an FMAP formula that is targeted for variable state Medicaid needs and provides automatic, timely, and temporary increased FMAP assistance in response to national economic downturns.
Open

As of March 2024, no legislation had been enacted. GAO has testified on at least one bill that had been introduced in the Congress that would implement this Matter for Congressional Consideration. On February 10, 2016, GAO testified on considerations related to the Medicaid funding formula. See Medicaid: Changes to Funding Formula Could Improve Allocation of Funds to States GAO-16-377T January 26, 2016. We also cited this report in our discussion on Medicaid funding during economic downturns in Medicaid: Key Policy and Data Considerations for Designing a Per Capita Cap on Federal Funding (GAO

E-Filing Tax Returns: Penalty Authority and Digitizing More Paper Return Data Could Increase Benefits

GAO-12-33
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1 Open Recommendations
Agency Recommendation Status
Congress Congressmay wish to consider amending the Internal Revenue Code to authorize IRS to assess penalties on preparers for failure to comply with section 6011(e)(3).
Open

A bill was introduced on June 28, 2011, which would have amended electronic filing requirements for paid preparers. This included language amending section 6695 of the Internal Revenue Code to include a penalty of $50 for failure to electronically file returns under section 6011 (e)(3). However, this bill was never enacted. As of March 2024, there are no bills pending that would provide IRS with authority to penalize paid preparers for failure to electronically file returns as GAO recommended.

Drug Pricing: Manufacturer Discounts in the 340B Program Offer Benefits, but Federal Oversight Needs Improvement

GAO-11-836
Debra A. Draper
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2 Open Recommendations
Agency Recommendation Status
Department of Health and Human Services PPACA contained several important program integrity provisions for the 340B program, and additional steps can also ensure appropriate use of the program. Therefore, the Secretary of HHS should instruct the administrator of HRSA to issue guidance to further specify the criteria that hospitals that are not publicly owned or operated must meet to be eligible for the 340B program.
Open

In January 2017, HRSA withdrew proposed guidance that included additional specificity regarding hospital eligibility. In March 2021, HRSA reported that it conducted an evaluation of its audit process and other program integrity efforts and determined that guidance does not provide the agency with appropriate enforcement capability. Therefore, HRSA indicated it would not be pursuing new guidance under the Program. In March 2024, HRSA noted that its existing regulatory authority to issue guidance is subject to ongoing legal challenges. HRSA officials told us that since FY2017 it had requested
Department of Health and Human Services PPACA contained several important program integrity provisions for the 340B program, and additional steps can also ensure appropriate use of the program. Therefore, the Secretary of HHS should instruct the administrator of HRSA to finalize new, more specific guidance on the definition of a 340B patient.
Open

In January 2017, HRSA withdrew proposed guidance that included further specificity on the definition of 340B patient. In March 2021, HRSA reported that it conducted an evaluation of its audit process and other program integrity efforts and determined that guidance does not provide the agency with appropriate enforcement capability. Therefore, HRSA indicated it would not be pursuing new guidance under the Program. In March 2024, HRSA noted that its existing regulatory authority to issue guidance is subject to ongoing legal challenges. HRSA officials told us that since FY2017 it had requested

Preventing Sexual Harassment: DOD Needs Greater Leadership Commitment and an Oversight Framework

GAO-11-809
Brenda S. Farrell
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Department of Defense
Priority Rec.
To enhance oversight of the department's program to help prevent and to address incidents of sexual harassment involving servicemembers, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to ensure that the Office of Diversity Management and Equal Opportunity develops and aggressively implements an oversight framework to help guide the department's efforts. At a minimum, such a framework should contain long-term goals, objectives, and milestones; strategies to accomplish goals; criteria for measuring progress; and results-oriented performance measures to assess the effectiveness of the department's sexual harassment policies and programs. Such a framework should also identify and include a plan for ensuring that adequate resources are available to carry out the office's oversight responsibilities.
Open

DOD concurred with our recommendation and stated that as part of its revised guidance it proposed to strengthen and institutionalize the responsibilities and authorities needed for successful implementation of the department's sexual harassment policies. In February 2018, DOD took action toward addressing this recommendation and issued an update to DOD Instruction 1020.03, Harassment Prevention and Response in the Armed Forces, that directs DOD's Office of Diversity, Equity, and Inclusion to ensure that DOD components' harassment prevention and response programs incorporate , at a minimum, (1)

Financial Derivatives: Disparate Tax Treatment and Information Gaps Create Uncertainty and Potential Abuse

GAO-11-750
James (Jay) R. McTigue, Jr
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1 Open Recommendations
Agency Recommendation Status
Department of the Treasury To better ensure that economically similar outcomes are taxed similarly and minimize opportunities for abuse, the Secretary of the Treasury should undertake a study that compares the current approach to alternative approaches for the taxation of financial derivatives. To determine if changes would be beneficial, such a study should weigh the tradeoffs to IRS and taxpayers that each alternative presents, including simplicity, administrability, and economic efficiency.
Open

Treasury disagreed with this recommendation based on the fact that many outside studies already exist and IRS did not comment. The Inflation Reduction Act enacted in August 2022 did not include any requirements that Treasury study alternative approaches for the taxation of financial derivatives. However, members of Congress in the 118th have discussed a mark-to-market tax system and the taxation of financial derivatives. GAO continues to maintain that further study is needed in coordination with IRS and will continue to monitor proposals for such a study.

Federal Reserve System: Opportunities Exist to Strengthen Policies and Processes for Managing Emergency Assistance

GAO-11-696
Orice Williams Brown
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1 Open Recommendations
Agency Recommendation Status
Board of Governors While creating control systems at the same time that the emergency programs were being designed and implemented posed unique challenges, the recent crisis provided invaluable experience that the Federal Reserve System can apply in the future should the use of these authorities again become warranted. Going forward, to further strengthen policies for selecting vendors, ensuring the transparency and consistency of decision making involving the implementation of any future emergency programs, and managing risks related to these programs, the Chairman of the Federal Reserve Board should direct Federal Reserve Board and Reserve Bank staff to document the Federal Reserve Board's guidance to Reserve Banks on types of emergency program decisions and risk events that require approval by or consultation with the Board of Governors, the Federal Open Market Committee, or other designated groups or officials at the Federal Reserve Board.
Open

We most recently sought information from the Board of Governors of the Federal Reserve System in June 2021 regarding the status of the recommendation but did not receive any new information. Therefore, the recommendation remains open.

Drinking Water: Unreliable State Data Limit EPA's Ability to Target Enforcement Priorities and Communicate Water Systems' Performance

GAO-11-381
David Trimble
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2 Open Recommendations
1 Priority
Agency Recommendation Status
Environmental Protection Agency
Priority Rec.
To improve EPA's ability to oversee the states' implementation of the Safe Drinking Water Act and provide Congress and the public with more complete and accurate information on compliance, the Administrator of EPA should resume data verification audits to routinely evaluate the quality of selected drinking water data on health-based and monitoring violations that the states provide to EPA. These audits should also evaluate the quality of data on the enforcement actions that states and other primacy agencies have taken to correct violations.
Open

EPA partially agreed with our recommendation. As of March 2023, EPA indicated that it continues to work on modernizing its Safe Drinking Water Information System (SDWIS) and expects to start transitioning states to the system by the end of 2024. In addition, EPA plans to engage with states as it develops data quality goals for monitoring violations and other information. However, our recommendation was that EPA should resume data verification audits. In March 2022, EPA told us it was not planning to resume the audits due to budgetary constraints. Instead, EPA said it was taking other actions
Environmental Protection Agency To improve EPA's ability to oversee the states' implementation of the Safe Drinking Water Act and provide Congress and the public with more complete and accurate information on compliance, the Administrator of EPA should work with the states to establish a goal, or goals, for the completeness and accuracy of data on monitoring violations. In setting these goals, EPA may want to consider whether certain types of monitoring violations merit specific targets. For example, the agency may decide that a goal for the states to completely and accurately report when required monitoring was not done should differ from a goal for reporting when monitoring was done but not reported on time.
Open

As of July 2023, this recommendation remains open. EPA is modernizing the Safe Drinking Water Information System (SDWIS), with several efforts underway. We are conducting additional follow-up with EPA staff to receive an update on the status of these efforts.

Abusive Tax Avoidance Transactions: IRS Needs Better Data to Inform Decisions about Transactions

GAO-11-493
James R. White
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1 Open Recommendations
Agency Recommendation Status
Congress Congress may wish to consider instituting a penalty on non-material advisor promoters for failing to provide investor lists to IRS within a specified time period when requested, comparable to the 20-business-day requirement for material advisors.
Open

As of March 2024, we have not identified legislative action on the three sections (26 U.S.C. ?? 6111, 6112, 6708) since the release of our report in 2011. No bills have been introduced into the current Congress (118th) to amend these sections of the Internal Revenue Code.

Medicaid and CHIP: Reports for Monitoring Children's Health Care Services Need Improvement

GAO-11-293R
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1 Open Recommendations
Agency Recommendation Status
Centers for Medicare & Medicaid Services In light of the need for accurate and complete information on children's access to health services under Medicaid and CHIP, the requirement that states report information to CMS on certain aspects of their Medicaid and CHIP programs, and problems with accuracy and completeness in this state reporting, the Administrator of CMS should work with states to identify additional improvements that could be made to the CMS 416 and CHIP annual reports, including options for reporting on the receipt of services separately for children in managed care and fee-for-service delivery models, while minimizing reporting burden, and for capturing information on the CMS 416 relating to children's receipt of treatment services for which they are referred.
Open – Partially Addressed

In August 2019, CMS stated that the agency's long-term plan is to use the Transformed Medicaid Statistical Information System (T-MSIS) to analyze information on children's receipt of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services. Starting with the submission of FY 2020 data, the CMS-416 was updated to provide an option for states that meet T-MSIS data quality and completeness criteria to have CMS complete the form on their behalf using T-MSIS data. As of December 2023, CMS officials said that they were still exploring the feasibility of using T-MSIS data to generate

Rural Housing Service: Opportunities Exist to Strengthen Farm Labor Housing Program Management and Oversight

GAO-11-329
A. Nikki Clowers
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1 Open Recommendations
Agency Recommendation Status
Department of Agriculture To better ensure that requirements for tenant eligibility are met across the FLH portfolio, the Secretary of Agriculture should direct the Administrator of RHS to require its loan servicers to use the Systematic Alien Verification and Entitlements (SAVE) program administered by the Department of Homeland Security to verify tenant's residency status during supervisory reviews.
Open

As of February 2024, USDA was taking steps to implement the use of electronic third-party verifications systems to establish tenant legal residency and income documentation. Officials reported that the draft rule incorporating the usage of Systematic Alien Verification and Entitlements (SAVE) program for verifying tenant residency is under departmental clearance review and they expect the rule to be finalized in late 2024. Officials reported they will not make any changes to its guidance to loans servicers on verifying tenants' residency until the rule is finalized. In addition, officials

2011 Tax Filing: IRS Dealt with Challenges to Date but Needs Additional Authority to Verify Compliance

GAO-11-481
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1 Open Recommendations
Agency Recommendation Status
Congress To ensure that IRS can adequately enforce certain tax provisions, Congress may wish to consider providing IRS with MEA to use tax return information from previous years to ensure that taxpayers do not improperly claim credits or deductions in excess of lifetime limits where applicable.
Open

As of March 2024, Congress had not provided IRS math error authority in these circumstances. GAO maintains that providing IRS with math error authority to identify and correct ineligible claims for credits or deductions in excess of lifetime limits would enable IRS to correct obvious noncompliance and would be less intrusive and burdensome to taxpayers than audits.

End-Stage Renal Disease: CMS Should Assess Adequacy of Payment When Certain Oral Drugs Are Included and Ensure Availability of Quality Monitoring Data

GAO-11-365
James Cosgrove
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1 Open Recommendations
Agency Recommendation Status
Centers for Medicare & Medicaid Services To help ensure that Medicare beneficiaries have access to high-quality dialysis care, the Administrator of CMS should assess the extent to which the bundled payment for dialysis care will be sufficient to cover an efficient dialysis organization's costs to provide such care when the bundled payment expands to cover oral-only ESRD drugs. The Administrator should conduct this assessment before implementing this expanded bundled payment.
Open

CMS, as required by law, delayed until 2025 the expansion of the bundled payment for dialysis care to cover oral-only ESRD drugs. Because the Protecting Access to Medicare Act of 2014 requires CMS to use the most recent year of data available to implement this payment change, CMS has been unable to implement our recommendation as of June 2023. We will update the status of this recommendation upon receipt of additional information from CMS.

Opportunities to Reduce Potential Duplication in Government Programs, Save Tax Dollars, and Enhance Revenue

GAO-11-318SP
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4 Open Recommendations
Agency Recommendation Status
Department of the Interior The Department of the Interior should implement GAO's recommendations from prior reports addressing a variety of oil and gas measurement factors.
Open – Partially Addressed

As of March 2024, Interior implemented 24 of 26 recommendations that GAO made in reports from March 2010 and April 2015 for improving Interior's oversight, polices, and practices for oil and gas measurement. Interior continues efforts to update oil and gas measurement and site security regulations. Interior plans to issue a notice of proposed rulemaking in December 2024, with a final rule expected in March 2025.
Office of Management and Budget Until the federal government has implemented effective processes to determine the full extent to which improper payments occur and to reasonably ensure that appropriate actions are taken across entities and programs to effectively recover and reduce improper payments, the federal government will not have reasonable assurance that the use of taxpayer funds is adequately safeguarded.
Open – Partially Addressed

As of January 2024, the federal government had taken some steps to estimate improper payments for susceptible programs and to recover overpayments. However, consistent with GAO's March 2011 suggested action, further efforts are needed to help ensure that all risk-susceptible programs are included, estimates are reliable, and improper payments are reduced. Executive agencies are required by law to determine whether any of their programs and activities are susceptible to significant improper payments and annually estimate and report the amount of improper payments in any susceptible programs and
Department of Defense Opportunities exist for the Department of Defense to optimize business operations and systems.
Open – Partially Addressed

DOD has taken steps to optimize its business operations and systems. For example, DOD has established tiered oversight processes for managing its portfolio of business systems. However, as of September 2023, updates to DOD's guidance and policy for its business systems are still needed. For example, in September 2023 DOD stated that they plan to issue updates to the investment management guidance that will contain requirements, procedures, and criteria to enable the DOD Chief Information Officer (CIO) to more effectively manage the department's portfolio of defense business systems. In
Congress Congress could consider giving the IRS the authority to collect the information that the Social Security Administration (SSA) needs on government pension income to administer the Government Pension Offset and the Windfall Elimination Provision accurately and fairly.
Open

No legislative action identified. As of March 2024, Congress had not yet passed legislation to give IRS authority to collect information that would provide SSA with accurate information on noncovered pension payments, as GAO suggested in November 2007. In prior years, the President's Budget submission proposed legislation that would provide seed money to states for them to develop systems that will enable them to provide information on their noncovered pension payments to SSA so that the agency can apply the Government Pension Offset and Windfall Elimination Provision. The proposal would
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