Recommendations Database | U.S. GAO

As of October 2, 2023, there are 5005 open recommendations that still need to be addressed. 521 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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1 - 20 of 398 Recommendations, including 52 Priority Recommendations

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Medicaid Program Integrity: Opportunities Exist for CMS to Strengthen Use of State Auditor Findings and Collaboration

Michelle Rosenberg

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2 Open Recommendations

Agency	Recommendation	Status
Centers for Medicare & Medicaid Services	The Administrator of CMS should annually examine state auditors' Medicaid findings to identify trends across states and use this information to inform oversight activities and audit processes. (Recommendation 1)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Centers for Medicare & Medicaid Services	The Administrator of CMS should build on the agency's efforts to collaborate with state auditors on Medicaid oversight activities. These collaboration efforts should include continuing to identify potential updates to the Compliance Supplement, having regular discussions to address auditor training needs, annually sharing information on trends in audit findings and program risks, and increasing auditor awareness of actions taken to address single audit findings. (Recommendation 2)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Medicare Part D: CMS Should Monitor Effects of Rebates on Plan Formularies and Beneficiary Spending

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1 Open Recommendations

Agency	Recommendation	Status
Centers for Medicare & Medicaid Services	The Administrator of CMS should monitor the effect of rebates on plan sponsor formulary design and on Medicare and beneficiary spending to assess whether rebate practices are likely to substantially discourage enrollment by certain beneficiaries.	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Defense Health Care: DOD Should Reevaluate Market Structure for Military Medical Treatment Facility Management

Brenda S. Farrell

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2 Open Recommendations

Agency	Recommendation	Status
Department of Defense	The Secretary of Defense should ensure that the Deputy Secretary of Defense, in coordination with the Under Secretary of Defense for Personnel and Readiness, prioritizes a reevaluation of its organizational approach for DHA's market-based management structure, including the possible consolidation under DHA headquarters of some or all management activities currently vested with market offices, and use the conclusions to study and validate workloads and personnel requirements. (Recommendation 1)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness establishes performance goals for its transition-related clinical and business reform initiatives, and then monitors the results in relation to projected savings. (Recommendation 2)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Unwanted Sexual Behavior: Improved Guidance, Access to Care, and Training Needed to Better Address Victims' Behavioral Health Needs

Brenda S. Farrell

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15 Open Recommendations

Agency	Recommendation	Status
Department of Defense	The Secretary of Defense should ensure that the Director of the Defense Health Agency develops guidance that establishes protocols specifying how and when providers should screen patients for experiences with unwanted sexual behavior. (Recommendation 1)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Secretary of Defense should ensure that as the department revises its guidance on health care management for patients who have experiences with unwanted sexual behavior, it considers modifications to clarify (1) when and how medical care should be prioritized for victims of unwanted sexual behavior, and (2) whether to expand the provisions about prioritization of care to include service members who have experienced sexual harassment. Any such revisions to the guidance should specify how providers can prioritize care for victims of unwanted sexual behavior in a manner that is consistent with DOD policy while also allowing them to effectively care for victims of other types of trauma. (Recommendation 2)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Secretary of Defense should include, as part of the department's planned study to implement the Independent Review Commission's recommendation to authorize service members' access to the full spectrum of VA care related to unwanted sexual behavior, consideration of several factors to balance confidentiality with mission needs to better facilitate implementing the Commission's recommendation to the greatest extent feasible. Specifically, the department's study should consider how best to enable such access by assessing the following: the extent that permitting greater access to VA behavioral health resources would pose risks to DOD that would be different from the risks DOD faces from service members who confidentially obtain care in the private sector; whether access to VA care without a referral could be granted for service members who are not in certain populations or positions that require greater disclosure; potential revisions of or clarifications to service member disclosure requirements related to behavioral health; and mechanisms that could help facilitate confidential access to care, such as distinctions between treatments that do and do not require disclosure. (Recommendation 3)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Secretary of Defense and the Secretary of Veterans Affairs should collaborate to take steps to ensure that service members who have experienced unwanted sexual behavior and are eligible for VA services related only to military sexual trauma are provided information about and connected to all programs that assist in the transition from DOD to VA care. (Recommendation 4)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Secretary of Defense should ensure that the Director of the Defense Health Agency adopts information security best practices for MHS GENESIS to incorporate the principle of least privilege and limit health record access to those with an established provider-patient relationship or a need to know, and therefore better ensure victim confidentiality and privacy. (Recommendation 5)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Veterans Affairs	The Secretary of Veterans Affairs, in conjunction with the Secretary of Defense, should develop and evaluate options and make a determination of the best approach for incorporating a mechanism in its new electronic health record whereby VA providers can record unwanted sexual behavior care at medical centers and community-based outpatient clinics while limiting sharing that information to the greatest extent feasible. (Recommendation 6)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Secretary of Defense should ensure that the Director of the Defense Health Agency issues guidance that specifies how information about behavioral health care related to experiences with unwanted sexual behavior should be consistently documented in the electronic health record. (Recommendation 7)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Director of the Office for Diversity, Equity, and Inclusion, revises harassment prevention and response training guidance to require that information about Department of Veterans Affairs resources for experiences with unwanted sexual behavior be included in annual or periodic training that is administered to all service members, and takes steps to ensure that the military services implement the revised guidance. (Recommendation 8)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Director of the Sexual Assault Prevention and Response Office, revises sexual assault prevention and response training guidance to require that information about Department of Veterans Affairs resources for experiences with unwanted sexual behavior be included in annual or periodic training that is administered to all service members, and takes steps to ensure that the military services implement the revised guidance. (Recommendation 9)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Deputy Assistant Secretary of Defense for Military Community and Family Policy, revises domestic sexual abuse training guidance to require that information about Department of Veterans Affairs resources for experiences with unwanted sexual behavior be included in annual or periodic training that is administered to all service members, and takes steps to ensure that the military services implement the revised guidance. (Recommendation 10)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Veterans Affairs	The Secretary of Veterans Affairs, in coordination with the Secretary of Defense, should revise the participant guide for the Transition Assistance Program's Department of Veterans Affairs benefits and services course taken by all separating service members to include information about available Department of Veterans Affairs resources for experiences with unwanted sexual behavior, similar to what is included in the Transition Assistance Program's optional course on women's health. (Recommendation 11)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness conducts a comprehensive evaluation to consider whether to modify DOD guidance on involuntary officer and enlisted administrative separations concerning medical examinations and higher-level general or flag officer reviews, including proposing changes to relevant statutes, as necessary. This evaluation should assess the following areas: (a) whether the eligible population should be service members who experienced any type of unwanted sexual behavior; (b) the appropriate timeframes between when an incident is reported and when a separation is proposed, and other eligibility restrictions for obtaining a medical examination or higher-level review; (c) which behavioral health conditions or diagnoses should determine eligibility for a behavioral health examination; (d) whether service members who file restricted reports should be eligible to request a general or flag officer review; and (e) whether to permit documentation of the alleged sexual assault in the report of the separation health assessment. (Recommendation 12)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of the Army	The Secretary of the Army should ensure that Army guidance on involuntary officer and enlisted administrative separations is modified to require that the Army's standardized separation notification correspondence includes information about the general or flag officer review for victims of sexual assault. (Recommendation 13)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of the Navy	The Secretary of the Navy should ensure that Navy guidance on involuntary officer and enlisted administrative separations is modified to require that the Navy's standardized separation notification correspondence includes information about the general or flag officer review for victims of sexual assault. (Recommendation 14)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of the Navy	The Secretary of the Navy should ensure that the Marine Corps guidance on involuntary officer and enlisted administrative separations is modified to require that the Marine Corps's standardized separation notification correspondence includes information about the general or flag officer review for victims of sexual assault. (Recommendation 15)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

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