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Priority Open Recommendations: Department of Health and Human Services

GAO-19-364SP Published: Mar 28, 2019. Publicly Released: Apr 08, 2019.
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Fast Facts

Each year, we make more than 1,000 recommendations to help improve the federal government. We alert department heads to the recommendations where they can save the most money, address issues on our High Risk List, or significantly improve government operations.

This report outlines our 54 priority open recommendations for HHS as of March 2019.

For example, in May 2018, we recommended that the Centers for Medicare & Medicaid Services mitigate certain risks to the Medicaid program, such as overpayments and payments for unallowable costs.

Since our previous letter in April 2018, HHS has implemented 13 of our priority recommendations.


Graphic showing that this report discusses GAO's 2019 priority recommendations for the Department of Health and Human Services

Graphic showing that this report discusses GAO's 2019 priority recommendations for the Department of Health and Human Services

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What GAO Found

In April 2018, GAO identified 57 priority open recommendations for the Department of Health and Human Services (HHS). Since then, HHS has implemented 13 of those recommendations by, for example, improving the transparency of the process for reviewing and approving spending limits for Medicaid demonstrations. In addition to the 13 recommendations HHS implemented, GAO removed the priority designation from two recommendations because they were either superseded by new priority recommendations or became a lower priority due to recent policy changes.

In March 2019, GAO identified 12 additional priority recommendations for HHS, bringing the total number to 54. These recommendations involve improving

  • the Medicare program's payment policy and design; 
  • oversight, accountability, and transparency of Medicaid spending; 
  • guidance, assessments, and collaboration to reduce improper payments in Medicare and Medicaid; 
  • security of health information technology; 
  • oversight of medical products and food imported into the United States; 
  • quality and timeliness of health care services provided by the Indian Health Service; 
  • oversight of efforts to address opioid use disorders; 
  • oversight of drug discounts provided through the Public Health Service Act; 
  • integrity of health insurance marketplace subsidies and enrollment; and 
  • oversight of federal awards and research grants.

HHS's continued attention to these issues could lead to significant improvements in government operations.

Why GAO Did This Study

Priority recommendations are open GAO recommendations that warrant priority attention from heads of key departments or agencies because their implementation could save large amounts of money; improve congressional and/or executive branch decision making on major issues; eliminate mismanagement, fraud, and abuse; or ensure that programs comply with laws and funds are legally spent, among other benefits. Since 2015 GAO has sent letters to selected agencies to highlight the importance of implementing such recommendations.

For more information, contact Angela N. Clowers at (202) 512-7114 or

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Compliance oversightHealth careHealth information technologyImproper paymentsInsurance premiumsMedicaidMedicaid programMedicareNative American health servicesPublic healthAudit recommendations