Recommendations Database

GAO’s recommendations database contains report recommendations that still need to be addressed. GAO’s priority recommendations are those that we believe warrant priority attention. We sent letters to the heads of key departments and agencies, urging them to continue focusing on these issues. Below you can search only priority recommendations, or search all recommendations.

Our recommendations help congressional and agency leaders prepare for appropriations and oversight activities, as well as help improve government operations. Moreover, when implemented, some of our priority recommendations can save large amounts of money, help Congress make decisions on major issues, and substantially improve or transform major government programs or agencies, among other benefits.

As of May 17, 2021, there are 4820 open recommendations, of which 378 are priority recommendations. Recommendations remain open until they are designated as Closed-implemented or Closed-not implemented.

Search Open Recommendations

1 - 11 of 11 Recommendations
Download CSV Download XLS

Cybersecurity: Agencies Need to Fully Establish Risk Management Programs and Address Challenges

Show
2 Open Recommendations
2 Priority
Agency Recommendation Status
Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
The Secretary of Health and Human Services should develop a cybersecurity risk management strategy that includes the key elements identified in this report. (Recommendation 10)
Open

The Department of Health and Human Services concurred with this recommendation. In March 2021, the department stated that its cybersecurity risk management strategy is undergoing internal review. The department did not provide a date that the review would be completed. Once the department has provided evidence of these actions, we plan to verify whether implementation has occurred.

Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
The Secretary of Health and Human Services should establish a process for conducting an organization-wide cybersecurity risk assessment. (Recommendation 12)
Open

The Department of Health and Human Services concurred with this recommendation. In March 2021, the department stated that a process for an organization-wide cybersecurity risk assessment is still under development and did not provide an estimated date of completion. Once the department has provided evidence of these actions, we plan to verify whether implementation has occurred.

Improper Payments: Selected Agencies Need Improvements in Their Assessments to Better Determine and Document Risk Susceptibility

Show
2 Open Recommendations
2 Priority
Agency Recommendation Status
Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
The Secretary of Health and Human Services should revise HHS's process for conducting improper payment risk assessments for Head Start to help ensure that it results in a reliable assessment of whether the program is susceptible to significant improper payments. This should include preparing sufficient documentation to support its risk assessments. (Recommendation 1)
Open

The Department of Health and Human Services (HHS) concurred with this recommendation. In fiscal year 2021, HHS provided us an update on its progress to address the recommendation. HHS stated that, in fiscal year 2020, HHS revised its risk assessment process, including the questionnaire and scoring methodology, and implemented a new tool, the Risk Assessment Portal (RAP) to capture responses. According to HHS, the revised questionnaire and RAP tool facilitates a systematic approach to conducting a reliable assessment of any HHS program, including Head Start, to determine whether the program is

Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
The Secretary of Health and Human Services should revise HHS's procedures for conducting improper payment risk assessments to help ensure that all programs and activities are assessed for susceptibility to significant improper payments at least once every 3 years, as required by IPIA. (Recommendation 2)
Open

The Department of Health and Human Services (HHS) concurred with this recommendation. In fiscal year 2021, HHS provided us an update on its progress to address the recommendation. HHS stated that it has used its new, risk-based methodology for two years to recommend programs for assessment. The results of this methodology, and the coverage recommended each year, is documented annually. This information is used by the Program leads to make their selection. The HHS Office of Inspector General reviewed the fiscal year 2019 methodology as part of the Annual Inspector General review of HHS's

Critical Infrastructure Protection: Additional Actions Are Essential for Assessing Cybersecurity Framework Adoption

Show
1 Open Recommendations
1 Priority
Agency Recommendation Status
Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
The Secretary of Health and Human Services, in cooperation 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 develop methods for determining the level and type of framework adoption by entities across their respective sector. (Recommendation 6)
Open

In written comments, the Department of Health and Human Services (HHS) concurred with the recommendation in our report and stated that it would work with appropriate entities to assist in sector adoption. In February 2020, HHS officials reported that in collaboration with NIST and a joint Cybersecurity Working Group, the agency developed 10 best practices in May 2017 (Health Industry Cybersecurity Practices) for the Healthcare and Public Health Services sector based on the framework. These practices allowed stakeholders to identify how to use the framework with existing sector resources by

Newborn Health: Federal Action Needed to Address Neonatal Abstinence Syndrome

Show
1 Open Recommendations
1 Priority
Agency Recommendation Status
Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
The Secretary of HHS should expeditiously develop a plan--that includes priorities, timeframes, clear roles and responsibilities, and methods for assessing progress--to effectively implement the NAS-related recommendations identified in the <i>Protecting Our Infants Act: Final Strategy.</i> (Recommendation 1)
Open

HHS concurred with this recommendation. HHS' Behavioral Health Coordinating Council finalized a plan for implementing the Strategy in 2019 . The plan includes priorities, timeframes, and clear roles and responsibilities for implementing NAS-related recommendations in the Strategy. The plan does not specifically identify methods for assessing progress on the recommendations, but HHS officials told us in November 2019 that the department holds quarterly conference calls to share updates and formal written updates will be collected at the end of each year. As of March 2021, we have not received

Improper Payments: Improvements Needed in CMS and IRS Controls over Health Insurance Premium Tax Credit

Show
1 Open Recommendations
1 Priority
Agency Recommendation Status
Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
To improve annual reporting on PTC improper payments, control activities related to eligibility determinations, and calculations of advance PTC, the Secretary of Health and Human Services should direct the Administrator of CMS to annually report improper payment estimates and error rates for the advance PTC program.
Open

The Department of Health and Human Services (HHS) concurred with this recommendation. On March 19, 2021, HHS's Centers for Medicare and Medicaid Services (CMS) provided us an update on its progress to address the recommendation. CMS stated that it has developed an improper payment measurement program for advance premium tax credit (PTC) payments made by the Federally-facilitated Exchange, and intends to publish an improper payment rate for benefit year 2020 in the fiscal year 2022 agency financial report. CMS is in the process of developing an improper payment measurement for advance PTC

Medicare: Claim Review Programs Could Be Improved with Additional Prepayment Reviews and Better Data

Show
1 Open Recommendations
1 Priority
Agency Recommendation Status
Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
In order to better ensure proper Medicare payments and protect Medicare funds, CMS should seek legislative authority to allow the RAs to conduct prepayment claim reviews.
Open

In April 2016, we recommended that the Centers for Medicare and Medicaid Services (CMS) should seek legislative authority to allow the Recovery Auditors (RAs) to conduct prepayment claim reviews. The Department of Health and Human Services did not concur with this recommendation, and, as of March 2021, CMS has not taken steps to seek such an authority. We continue to believe CMS should seek legislative authority to allow RAs to conduct these reviews. Until CMS seeks and implements this authority, it will be missing an opportunity to help identify improper payments before they are made.

Unaccompanied Alien Children: Actions Needed to Ensure Children Receive Required Care in DHS Custody

Show
1 Open Recommendations
1 Priority
Agency Recommendation Status
Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
To increase the efficiency and improve the accuracy of the interagency UAC referral and placement process, the Secretaries of Homeland Security and Health and Human Services should jointly develop and implement a documented interagency process with clearly defined roles and responsibilities, as well as procedures to disseminate placement decisions, for all agencies involved in the referral and placement of UAC in HHS shelters.
Open

In November 2020, DHS officials told us that, in coordination with HHS and other agencies, DHS is developing a Unified Immigration Portal (UIP) to enable a more complete understanding of an individual's journey throughout the immigration system. Specifically, the UIP is intended to be a technological platform where authorized U.S. government users can access relevant immigration-related data from multiple agencies through a single interface. DHS officials told us in February 2021 that the portal is to provide real time data to track unaccompanied children from the time of apprehension to their

Food Safety: FDA and USDA Should Strengthen Pesticide Residue Monitoring Programs and Further Disclose Monitoring Limitations

Show
1 Open Recommendations
1 Priority
Agency Recommendation Status
Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
To better inform users of the annual monitoring report about the frequency and scope of pesticide tolerance violations, the Secretary of Health and Human Services should direct the Commissioner of FDA to disclose in the agency's annual pesticide monitoring program report which pesticides with EPA-established tolerances the agency did not test for in its pesticide monitoring program and the potential effect of not testing for those pesticides.
Open

As of March 2021, HHS concurred with our recommendation. FDA acknowledged in its latest annual pesticide residue monitoring report, issued in September 2020, that some pesticides with Environmental Protection Agency-established tolerances were not part of the FDA testing scope, and that FDA does not know the extent to which exposure to these pesticides may occur in the foods that FDA regulates. In addition, FDA included in this report an appendix listing all pesticides analyzed by FDA pesticide methods in that fiscal year. To fully implement our recommendation, FDA must disclose in its annual

Medicaid and SCHIP: Recent HHS Approvals of Demonstration Waiver Projects Raise Concerns

Show
1 Open Recommendations
1 Priority
Agency Recommendation Status
Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
To meet its fiduciary responsibility of ensuring that section 1115 waivers are budget neutral, the Secretary of Health and Human services should better ensure that valid methods are used to demonstrate budget neutrality, by developing and implementing consistent criteria for consideration of section 1115 demonstration waiver proposals.
Open

As of March 2021, the Department of Health and Human Services (HHS) had taken some action to address GAO's 2002 recommendation. In August 2018, HHS issued written guidance through a State Medicaid Directors Letter documenting four key changes it made in 2016 to its budget neutrality policy. These changes addressed some, but not all of the questionable methods GAO identified in its reports. To fully address this recommendation, HHS should also address these other questionable methods, such as setting demonstration spending limits based on hypothetical costs--what the state could have paid-

Have a Question about a Recommendation?

For questions about a specific recommendation, contact the person or office listed with the recommendation. For general information about recommendations, contact GAO's Audit Policy and Quality Assurance office at (202) 512-6100 or apqa@gao.gov.