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As of February 1, 2023, there are 4825 open recommendations that still need to be addressed. 464 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 - 14 of 14 Recommendations, including 3 Priority Recommendations

Payment Integrity: Selected Agencies Should Improve Efforts to Evaluate Effectiveness of Corrective Actions to Reduce Improper Payments

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1 Open Recommendations
Agency Recommendation Status
Office of the Secretary for HHS The Secretary of Health and Human Services should document in policies and procedures HHS's improper payment corrective action plan process. As part of these procedures, HHS should include processes for (1) establishing planned completion dates, (2) monitoring the progress of implementing corrective actions, and (3) measuring the effectiveness of improper payment corrective actions. The process for measuring the effectiveness of corrective actions should clearly demonstrate the effect HHS's corrective actions have on reducing improper payments. (Recommendation 4)
Open

The Department of Health and Human Services (HHS) disagreed with this recommendation. In commenting on our draft report, HHS elaborated on the improper payment corrective action plan process that is called for in the Office of Management and Budget (OMB) guidance. HHS stated that OMB guidance provides agencies the flexibility to measure the effectiveness of corrective actions and believes that this flexibility is vital to its oversight processes to reduce improper payments. In November 2020, HHS stated that they continue to disagree with the recommendation. In fiscal year 2021, we sent

Antibiotic Resistance: Additional Federal Actions Needed to Better Determine Magnitude and Reduce Impact

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3 Open Recommendations
Agency Recommendation Status
Office of the Secretary for HHS The Secretary of HHS should identify leadership and clarify roles and responsibilities among HHS agencies to assess the clinical outcomes of diagnostic testing for identifying antibiotic-resistant bacteria. (Recommendation 5)
Open – Partially Addressed

HHS agreed with GAO's March 2020 recommendation and had taken some actions to implement it. As of December, 2021, HHS reported that its actions to address this recommendation included (1) introducing an objective within the diagnostic test goal of the 2020-2025 National Action Plan to support research into appropriate use of diagnostic tests; (2) designating the agencies (Agency for Healthcare Research and Quality, CDC, NIH, and the Military Infectious Diseases Research Program) assigned to this objective; and (3) coordinating activities, providing guidance, and compiling progress reports

Office of the Secretary for HHS The Secretary of HHS should develop a strategic framework to further incentivize the development of new treatments for antibiotic-resistant infections, including through the use of postmarket financial incentives, and, if appropriate, make recommendations to Congress for necessary authority. (Recommendation 7)
Open – Partially Addressed

The Department of Health and Human Services did not concur with GAO's recommendation. In commenting on our report, the department noted that it has convened a work group to develop a strategic framework that includes proposals to address a variety of challenges facing antibiotic product developers and agreed that additional incentives are needed. However, the department stated it was still analyzing whether postmarket financial incentives should be included in this framework. As of June 2021, the department stated that it is committed to enhancing efforts to promote sustainability of the

Office of the Secretary for HHS The Secretary of HHS should direct the CARB Task Force to include in its annual updates to the President plans for addressing any barriers preventing full implementation of the National Action Plan and, as appropriate, make recommendations for new or modified actions. Specifically, the CARB Task Force should identify plans to address barriers, such as those related to expanding (1) a CDC program designed to strengthen the U.S. response to resistant gonorrhea; (2) antibiotic stewardship programs across health care settings; and (3) antibiotic use data collection across health care settings, to the extent feasible. (Recommendation 8)
Open – Partially Addressed

The Department of Health and Human Services concurred with this recommendation, and stated that beginning in 2020 and continuing annually thereafter, the CARB Task Force's progress reports will include discussion of any barriers preventing full implementation of the National Action Plan, including, as appropriate, barriers that GAO has identified. Due to the COVID-19 pandemic, the CARB Task Force was delayed in developing the final progress report for the original National Action Plan. As of June 2021, it anticipates publishing the final progress report in fall 2021. In May, 2022, HHS

Sexual Harassment in STEM Research: Agencies Have Taken Actions, but Need Complaint Procedures, Overall Plans, and Better Collaboration

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1 Open Recommendations
Agency Recommendation Status
Office of the Secretary for HHS The Secretary of the Department of Health and Human Services should establish goals and an overall plan to assess all of the agency's sexual harassment prevention efforts for their university grantees, including methods to regularly monitor and evaluate its sexual harassment prevention policies and communication mechanisms (e.g. Title IX or sex discrimination websites). (Recommendation 13)
Open – Partially Addressed

HHS agreed with the recommendation. HHS-NIH created goals for all NIH grantee sexual harassment prevention efforts and as of October 2020, HHS-NIH and HHS's Office of Civil Rights (OCR) developed and implemented an overall plan to: (1) assess HHS efforts to promote sexual harassment prevention efforts at NIH-funded universities, and (2) assess methods to regularly monitor and evaluate the grant and enforcement policies and communication mechanisms employed by NIH and OCR under their respective civil rights and grant authorities to promote the prevention of sexual harassment at NIH-funded

Critical Infrastructure Protection: Additional Actions Needed to Identify Framework Adoption and Resulting Improvements

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1 Open Recommendations
Agency Recommendation Status
Office of the Secretary for HHS The Secretary of Health and Human Services, in coordination 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 collect and report sector-wide improvements from use of the framework across its critical infrastructure sector using existing initiatives. (Recommendation 7)
Open

In written comments, the Department of Health and Human Services (HHS) stated that it concurred with our recommendation. HHS does not yet have efforts underway to identify sector-wide improvements from use of the framework. However, the agency has taken steps to encourage improvement in cybersecurity through use of the framework. Specifically, officials noted that 192 health care and public health entities within the sector are participating in the Department of Homeland Security's Cybersecurity and Infrastructure Security Agency's cybersecurity assessments and vulnerability scanning to

National Biodefense Strategy: Additional Efforts Would Enhance Likelihood of Effective Implementation

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3 Open Recommendations
3 Priority
Agency Recommendation Status
Office of the Secretary for HHS
Priority Rec.
This is a priority recommendation.
The Secretary of HHS should direct the Biodefense Coordination Team to establish a plan that includes change management practices—such as strategies for feedback, communication, and education—to reinforce collaborative behaviors and enterprise-wide approaches and to help prevent early implementation challenges from becoming institutionalized. (Recommendation 1)
Open

HHS agreed with our recommendation and, in April 2021, described actions it has taken to implement it, but did not provide supporting documentation that would allow GAO to assess the extent to which these actions respond to the report findings and meet the intent of the recommendation. To fully implement the recommendation, HHS will need to provide evidence of the communication strategy and plan it created and that evidence will need to demonstrate that the actions respond effectively to the change-management related report findings. HHS will also need to provide evidence of the feedback

Office of the Secretary for HHS
Priority Rec.
This is a priority recommendation.
The Secretary of HHS should direct the Biodefense Coordination Team to clearly document guidance and methods for analyzing the data collected from the agencies, including ensuring that nonfederal resources and capabilities are accounted for in the analysis. (Recommendation 2)
Open

HHS agreed with our recommendation and, in April 2021, described actions it has taken to implement it, but did not provide supporting documentation that would allow GAO to assess the extent to which these actions respond to the report findings and meet the intent of the recommendation. For example, HHS described that standard operating procedures are in development to further codify the annual assessment process. To fully implement this recommendation, HHS will need to document standard operating procedures, and the procedures must outline how the Biodefense Coordination Team plans to account

Office of the Secretary for HHS
Priority Rec.
This is a priority recommendation.
The Secretary of HHS should direct the Biodefense Coordination Team to establish a resource plan to staff, support, and sustain its ongoing efforts. (Recommendation 3)
Open

HHS agreed with our recommendation and, in April 2021, described actions it has taken to implement it, but did not provide supporting documentation that would allow GAO to assess the extent to which these actions respond to the report findings and meet the intent of the recommendation. For example, HHS submitted a budget request for $5 million to support implementation of the National Biodefense Strategy. To fully implement this recommendation, HHS will need to provide a detailed plan on how such budget requests will be used to staff, support, and sustain ongoing implementation efforts. This

Cloud Computing Security: Agencies Increased Their Use of the Federal Authorization Program, but Improved Oversight and Implementation Are Needed

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5 Open Recommendations
Agency Recommendation Status
Office of the Secretary for HHS The Secretary of HHS should direct the Administrator of CMS to update the security assessment report for selected system to identify the summarized results of control effectiveness tests. (Recommendation 12)
Open

In November 2021, CMS provided evidence to close this recommendation. However, the evidence was not sufficient to close the recommendation. We will follow-up with the agency to obtain additional documentation and continue to monitor the agency's efforts to implement this recommendation.

Office of the Secretary for HHS The Secretary of HHS should direct the Director of NIH to update security plans for selected systems to identify the authorization boundary, system operation in terms of mission and business processes, operational environment and connections, and a description of security controls. (Recommendation 15)
Open

In June 2022, NIH decommissioned one of the selected systems. We requested additional documentation for the other selected system in June 2022. Once we receive supporting documentation, we will provide updated information.

Office of the Secretary for HHS The Secretary of HHS should direct the Director of NIH to update the security assessment report for selected systems to identify summarized results of control effectiveness tests. (Recommendation 16)
Open

In June 2022, NIH decommissioned one of the selected systems. We requested additional documentation for the other selected system in June 2022. Once we receive supporting documentation, we will provide updated information.

Office of the Secretary for HHS The Secretary of HHS should direct the Director of NIH to update the NIH list of corrective actions for selected systems to identify estimated funding and anticipated source of funding, key milestones with completion dates, and changes to milestones and completion dates. (Recommendation 17)
Open

In June 2022, NIH decommissioned one of the selected systems. We requested additional documentation for the other selected system in June 2022. Once we receive supporting documentation, we will provide updated information.

Office of the Secretary for HHS The Secretary of HHS should direct the Director of NIH to submit the division's letters authorizing the use of cloud services for the selected systems to the FedRAMP program management office. (Recommendation 18)
Open

In June 2022, NIH decommissioned one of the selected systems. We requested additional documentation for the other selected system in June 2022. Once we receive supporting documentation, we will provide updated information.

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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.