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Open Recommendations (3 total)

Payment Integrity: Selected Agencies Should Improve Efforts to Evaluate Effectiveness of Corrective Actions to Reduce Improper Payments

GAO-20-336
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1 Open Recommendations
Agency Affected Recommendation Status
Office of the Secretary for HHS The Secretary of Health and Human Services should document in policies and procedures HHS's improper payment corrective action plan process. As part of these procedures, HHS should include processes for (1) establishing planned completion dates, (2) monitoring the progress of implementing corrective actions, and (3) measuring the effectiveness of improper payment corrective actions. The process for measuring the effectiveness of corrective actions should clearly demonstrate the effect HHS's corrective actions have on reducing improper payments. (Recommendation 4)
Open – Partially Addressed
The Department of Health and Human Services (HHS) disagreed with this recommendation. In commenting on our draft report, HHS stated that the Office of Management and Budget (OMB) guidance provides agencies the flexibility to measure the effectiveness of corrective actions and believes that this flexibility is vital to its oversight processes to reduce improper payments. Despite HHS's initial disagreement with this recommendation, in February 2023, HHS told us that it uses a variety of methods to provide standard operating procedures when requesting updates to its corrective action plans (CAP). HHS mentioned it conducts a kickoff meeting; sends email with detailed instructions for updating CAPs; and uses a scorecard which updates key initiatives, recent accomplishments, and upcoming goals. Therefore, HHS considers this recommendation closed as implemented. Based on our review of HHS's kickoff meeting briefing slides, email correspondence, and scorecard template, we believe that HHS has partially addressed this recommendation. HHS's scorecard covers "establishing planned completion dates" and "monitoring the progress of implementing corrective actions," which are the first two processes mentioned in the recommendation. However, HHS's scorecard does not cover "measuring the effectiveness of improper payment corrective actions," which is the third process mentioned in the recommendation. In addition, HHS's scorecard seems to only be used for "high-priority" programs and is used to populate the scorecard information that OMB includes on paymentaccuracy.gov. To address this recommendation, HHS needs to have procedures that are applicable to all programs reporting improper payment estimates and not just for those procedures which are part of HHS's high-priority reporting requirements. In addition, HHS's process for measuring the effectiveness of corrective actions should clearly demonstrate the effect HHS's corrective actions have on reducing improper payments. As of February 2024, HHS stated that it is working on the corrective action tracking, monitoring, and evaluation processes and has met with other agencies about their department-wide approaches. In addition, HHS stated that it is currently reviewing information about other agencies' approaches and will provide another update later in 2024. We will continue to monitor HHS's actions to address this recommendation.

Antibiotic Resistance: Additional Federal Actions Needed to Better Determine Magnitude and Reduce Impact

GAO-20-341
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1 Open Recommendations
Agency Affected Recommendation Status
Office of the Secretary for HHS The Secretary of HHS should identify leadership and clarify roles and responsibilities among HHS agencies to assess the clinical outcomes of diagnostic testing for identifying antibiotic-resistant bacteria. (Recommendation 5)
Open – Partially Addressed
HHS agreed with GAO's March 2020 recommendation and had taken some actions to implement it. As of December, 2021, HHS reported that its actions to address this recommendation included (1) introducing an objective within the diagnostic test goal of the 2020-2025 National Action Plan to support research into appropriate use of diagnostic tests; (2) designating the agencies (Agency for Healthcare Research and Quality, CDC, NIH, and the Military Infectious Diseases Research Program) assigned to this objective; and (3) coordinating activities, providing guidance, and compiling progress reports. However, the Combating Antibiotic-Resistant Bacteria Task Force stated it did not feel designating a single leader for these activities was warranted, relying instead on the agencies to conduct work based on their respective missions. In May 2022, HHS officials stated that the CARB Task Force provides leadership for the National Action Plan and that several teleconferences were held to communicate ongoing and upcoming work in which the agencies responsible for the relevant objective participated. In April 2023, HHS provided examples of activities conducted by several agencies to advance development and use of diagnostic tests. However, more specific documented details of how the agencies' mission translate into roles and responsibilities to address the objective can help agencies better manage fragmentation, which can help improve patient care and guide appropriate antibiotic use. We will update this recommendation as we receive more information.

Critical Infrastructure Protection: Additional Actions Needed to Identify Framework Adoption and Resulting Improvements

GAO-20-299
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1 Open Recommendations
Agency Affected Recommendation Status
Office of the Secretary for HHS The Secretary of Health and Human Services, in coordination with the Secretary of Agriculture, should take steps to consult with respective sector partner(s), such as the SCC, DHS, and NIST, as appropriate, to collect and report sector-wide improvements from use of the framework across its critical infrastructure sector using existing initiatives. (Recommendation 7)
Open – Partially Addressed
The Department of Health and Human Services (HHS) concurred with our recommendation and has taken actions towards implementing it. In April 2023, HHS released the Hospital Cyber Resiliency Initiative: Landscape Analysis, which identified the extent that hospitals participating in the study reported adoption of the NIST cybersecurity framework. However, as of February 2024 HHS has not yet collected and reported on sector-wide improvements from the use of the framework. Until HHS implements this recommendation, it may not fully understand the value of the framework and approaches that could be prioritized in helping protect the healthcare and public health sector from cyber threats. In addition, HHS coordinated with the Department of Agriculture in taking initial steps to determine framework adoption across the food and agricultural sector by distributing two requests for information to food and agriculture sector members. However, those efforts did not generate enough responses to be useful. For instance, the Department of Agriculture did not receive any responses from private sector members regarding plans to implement, adopt, and measure improvements resulting from use of the framework. The Department of Agriculture stated that it has collaborated with HHS and the DHS to determine if there are alternative methods for collecting and assessing more substantive information. As of February 2024, HHS and the other agencies have not yet identified alternative approaches or completed or other actions for collecting and reporting on sector-wide improvements in the food and agriculture sector. We will continue to monitor the agency's progress in implementing our recommendation.
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