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    Subject Term: "Advance payments"

    2 publications with a total of 6 open recommendations including 1 priority recommendation
    Director: King, Kathleen M
    Phone: (202) 512-7114

    1 open recommendations
    including 1 priority recommendation
    Recommendation: In order to promote greater use of effective prepayment edits and better ensure proper payment, and to promote implementation of effective edits based on national policies, the CMS Administrator should develop written procedures to provide guidance to agency staff on all steps in the processes for developing and implementing edits based on national policies, including (1) time frames for taking corrective actions, (2) methods for assessing the effects of corrective actions, and (3) procedures for ensuring consideration of automated edits whenever possible, including for all existing NCDs and other national policies.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open
    Priority recommendation

    Comments: HHS concurred with this recommendation. CMS developed written procedures in November 2012 to provide guidance to agency staff on procedures for ensuring consideration of automated edits whenever possible, as GAO recommended in November 2012, but these procedures do not include several key elements of GAO's recommendation. For example, the written procedures do not include time frames for making decisions on whether an edit will be developed for all existing National Coverage Determinations (NCD) and national policies. The written procedures also do not include requirements for methods to assess the effects of corrective actions taken. Implementing a comprehensive written process for developing edits for national policies could help ensure that edits are implemented whenever possible to reduce improper payments. As of September 2017, CMS had not provided us updated documentation that addressed these aspects of our recommendation. Once received, we will review the information and update this recommendation accordingly.
    Director: Brown, Orice Williams
    Phone: (202) 512-3000

    5 open recommendations
    Recommendation: To provide transparency and accountability over the payments FEMA makes to WYOs for expenses and profits, the Secretary of Homeland Security should direct the Under Secretary of Homeland Security, FEMA, to determine in advance the amounts built into the payment rates for estimated expenses and profit.

    Agency: Department of Homeland Security
    Status: Open

    Comments: FEMA is continuing (as of 08/29/2014) to analyze Write-Your-Own (WYO) payments and related flood expenses for selected companies and is evaluating the reliability (accuracy, consistency, etc.) of the National Association of Insurance Commissioners (NAIC) data for purposes of performing the analysis we had recommended.
    Recommendation: To provide transparency and accountability over the payments FEMA makes to WYOs for expenses and profits, the Secretary of Homeland Security should direct the Under Secretary of Homeland Security, FEMA, to annually analyze the amounts of actual expenses and profit in relation to the estimated amounts used in setting payment rates.

    Agency: Department of Homeland Security
    Status: Open

    Comments: In its initial response to this report, FEMA did not concur with this recommendation. In November 2016, FEMA restated its position and concurs with this recommendation, and is in the process of implementing it.
    Recommendation: To provide transparency and accountability over the payments FEMA makes to WYOs for expenses and profits, the Secretary of Homeland Security should direct the Under Secretary of Homeland Security, FEMA, to consider the results of the analysis of payments, actual expenses, and profit in evaluating the methods for paying WYOs.

    Agency: Department of Homeland Security
    Status: Open

    Comments: FEMA is continuing (as of 08/29/2014) to analyze WYO payments and related flood expenses for selected companies and is evaluating the reliability (accuracy, consistency, etc.) of the National Association of Insurance Commissioners (NAIC) data for purposes of performing the analysis we had recommended.
    Recommendation: To increase the usefulness of the data reported by WYOs to the National Association of Insurance Commissioners (NAIC) and to institutionalize FEMA's use of such data, the Secretary of Homeland Security should direct the Under Secretary of Homeland Security, FEMA, to take actions to obtain reasonable assurance that NAIC flood insurance expense data can be considered in setting payment rates that are appropriate, including identifying affiliated company profits in reported flood insurance expenses.

    Agency: Department of Homeland Security
    Status: Open

    Comments: FEMA continues (as of 08/29/2014) to work with the National Association of Insurance Commissioners (NAIC) to improve the consistency with which commission, operating, and loss adjustment expenses are reported by insurance companies that participate in the National Flood Insurance Program.
    Recommendation: To increase the usefulness of the data reported by WYOs to the National Association NAIC and to institutionalize FEMA's use of such data, the Secretary of Homeland Security should direct the Under Secretary of Homeland Security, FEMA, to develop comprehensive data analysis strategies to annually test the quality of flood insurance data that WYOs report to NAIC.

    Agency: Department of Homeland Security
    Status: Open

    Comments: FEMA continues (as of 08/29/2014) to work with the National Association of Insurance Commissioners (NAIC) to improve the consistency with which commission, operating, and loss adjustment expenses are reported by insurance companies that participate in the National Flood Insurance Program.