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 December 1, 2021, there are 4659 open recommendations, of which 482 are priority recommendations. Recommendations remain open until they are designated as Closed-implemented or Closed-not implemented.

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1 - 20 of 20 Recommendations
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COVID-19: Critical Vaccine Distribution, Supply Chain, Program Integrity, and Other Challenges Require Focused Federal Attention

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2 Open Recommendations
2 Priority
Agency Recommendation Status
Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
To improve the federal government's response to COVID-19 and preparedness for future pandemics, the Secretary of Health and Human Services should immediately establish an expert committee or use an existing one to systematically review and inform the alignment of ongoing data collection and reporting standards for key health indicators. This committee should include a broad representation of knowledgeable health care professionals from the public and private sectors, academia, and nonprofits. (Recommendation 6)
Open

HHS partially agreed with our recommendation. As of July 2021, HHS stated that it plans to consider ways to establish more permanent work groups to incorporate best practices for ongoing interagency data needs and to scale up as necessary during future public health emergencies. HHS also stated that the Data Strategy and Execution Workgroup, established as part of the HHS COVID-19 response, has helped address the need for a federal interagency coordination process to align ongoing COVID-19 data collection and reporting efforts. We maintain that immediately establishing an expert committee-not

Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
The Secretary of Health and Human Services should develop and make publicly available a comprehensive national COVID-19 testing strategy that incorporates all six characteristics of an effective national strategy. Such a strategy could build upon existing strategy documents that the Department of Health and Human Services has produced for the public and Congress to allow for a more coordinated pandemic testing approach. (Recommendation 3)
Open

HHS partially agreed with our recommendation. In January 2021, HHS agreed that the department should take steps to more directly incorporate some of the elements of an effective national strategy, but expressed concern that producing such a strategy at this time could be overly burdensome on the federal, state, and local entities that are responding to the pandemic, and that a plan would be outdated by the time it was finalized or potentially rendered obsolete by the rate of technological advancement. In May 2021, HHS told us that the White House and HHS plan to execute a National Testing

COVID-19: Federal Efforts Could Be Strengthened by Timely and Concerted Actions

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5 Open Recommendations
5 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 coordination with the Administrator of the Federal Emergency Management Agency—who head agencies leading the COVID-19 response through the Unified Coordination Group—should immediately document roles and responsibilities for supply chain management functions transitioning to the Department of Health and Human Services, including continued support from other federal partners, to ensure sufficient resources exist to sustain and make the necessary progress in stabilizing the supply chain, and address emergent supply issues for the duration of the COVID-19 pandemic. (Recommendation 1)
Open

HHS disagreed with our recommendation. In a May 2021 update, the Office of the Assistant Secretary for Preparedness and Response (ASPR) noted that since March 2020, supply chain responsibility, coordination, and execution have been incorporated and integrated into ASPR. HHS stated that ASPR's supply chain work is divided into three areas: (1) logistics and supply chain management, (2) supply chain and industrial situational awareness, and (3) industrial base expansion. The update noted that this work provides solutions to HHS and other federal partners to address supply chain shortages and

Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
The Secretary of Health and Human Services in coordination with the Administrator of the Federal Emergency Management Agency—who head agencies leading the COVID-19 response through the Unified Coordination Group—should further develop and communicate to stakeholders plans outlining specific actions the federal government will take to help mitigate remaining medical supply gaps necessary to respond to the remainder of the pandemic, including through the use of Defense Production Act authorities. (Recommendation 2)
Open

HHS disagreed with our recommendation. However, HHS has taken some action that would implement this recommendation. In a May 2021 update, ASPR noted that since March 2020, supply chain responsibility, coordination, and execution has been incorporated and integrated into ASPR. HHS stated that ASPR's supply chain work is divided into three areas: (1) logistics and supply chain management, (2) supply chain and industrial situational awareness, and (3) industrial base expansion. The update noted that this work provides solutions to HHS and other federal partners to address supply chain shortages

Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
The Secretary of Health and Human Services—who heads one of the agencies leading the COVID-19 response through the Unified Coordination Group—consistent with their roles and responsibilities, should work with relevant federal, state, territorial, and tribal stakeholders to devise interim solutions, such as systems and guidance and dissemination of best practices, to help states enhance their ability to track the status of supply requests and plan for supply needs for the remainder of the COVID-19 pandemic response. (Recommendation 3)
Open

HHS disagreed with this recommendation, noting, among other things, work that had already been done to manage the medical supply chain and increase supply availability. As of May 2021, HHS has not demonstrated action to devise interim solutions that would systematically help states, tribes, and territories effectively track, manage, and plan for supplies to carry out the COVID-19 pandemic response in the absence of state-level end-to-end logistics capabilities that would track critical supplies required for a response of this scale. We note that we made this recommendation to both HHS and the

Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
The Secretary of Health and Human Services, with support from the Secretary of Defense, should establish a time frame for documenting and sharing a national plan for distributing and administering COVID-19 vaccine, and in developing such a plan ensure that it is consistent with best practices for project planning and scheduling and outlines an approach for how efforts will be coordinated across federal agencies and nonfederal entities. (Recommendation 5)
Open

CDC issued initial planning documents in September and October 2020, and in January 2021, the White House issued a national COVID-19 response strategy that broadly outlined various programs for vaccine distribution. These documents contain general information on federally supported vaccine distribution activities, but do not provide details related to how the federal government is coordinating its efforts or information on the specific roles of the federal agencies and non-federal entities.

Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
The Secretary of Health and Human Services, in consultation with the Centers for Medicare & Medicaid Services and CDC, should develop a strategy to capture more complete data on confirmed COVID-19 cases and deaths in nursing homes retroactively back to January 1, 2020, and to clarify the extent to which nursing homes have reported data before May 8, 2020. To the extent feasible, this strategy to capture more complete data should incorporate information nursing homes previously reported to CDC or to state or local public health offices. (Recommendation 15)
Open

HHS partially agreed with our recommendation. As of May 2021, HHS had taken no specific action, although according to HHS it continues to consider how to implement our recommendation. We will continue to monitor HHS's progress toward implementing this recommendation. As of September 2021, there are no additional updates.

Infectious Disease Modeling: Opportunities to Improve Coordination and Ensure Reproducibility

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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 mechanism to routinely monitor, evaluate, and report on coordination efforts for infectious disease modeling across multiple agencies. (Recommendation 1)
Open

The Department of Health and Human Services concurred with this recommendation and stated, as of February 2021, it is developing a process whereby it will coordinate its efforts in infectious disease modeling across its components, including efforts to monitor, evaluate and report on its coordination. When the process is finalized and we confirm that it includes efforts to monitor, evaluate and report on coordination, we will provide updated information.

Department of Health and Human Services
Priority Rec.
This is a priority recommendation.
The Secretary of Health and Human Services should direct CDC to establish guidelines that ensure full reproducibility of CDC's research by sharing with the public all permissible and appropriate information needed to reproduce research results, including, but not limited to, model code. (Recommendation 2)
Open

The Centers for Disease Control and Prevention concurred with this recommendation. In February 2021, CDC stated its modelers aim to make forecasts and other modeling products reproducible and accessible and said it is focused on transparency and accessibility in its modeling efforts, noting that it broadly disseminates modeling findings to state and local partners. However, CDC has not taken steps to update its guidelines for ensuring and maximizing the quality, objectivity, utility, and integrity of information disseminated to the public, such as by modifying its guidelines to include

Southwest Border: Actions Needed to Improve DHS Processing of Families and Coordination between DHS and HHS

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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, jointly with the Secretary of Homeland Security, should collaborate to address information sharing gaps identified in this report to ensure that ORR receives information needed to make decisions for UAC, including those apprehended with an adult. (Recommendation 9)
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

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

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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

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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 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 and documentation 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. HHS plans to refine the methodology as needed and ensure annually that Program leads are aware of which programs are above

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

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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

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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 Protecting Our Infants Act: Final Strategy. (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

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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

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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 the President's 2022 fiscal year budget proposal did not include a request for such an authority. We continue to believe that 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

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

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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

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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

FDA acknowledged in its 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 pesticide residue monitoring report which pesticides with

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

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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-

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