Look at DISTRIBUTIONS of usage by county. Distribution is typically in a band and very stable Outliers point to fraud.Past used. Further support given by follow up interviews

Performance excellence standards begins with Leadership and a model. The Baldrige model has worked for other government agencies, hospitals, schools and businesses. Why not give it a try?

Sitting is recognized by health professionals as one of the most problematic positions in which to spend most of our days. Yet, that is how many of us spend our workday, commute, etc. Here is just one short article about how prolonged sitting can impact your health: http://www.webmd.com/fitness-exercise/news/20100119/prolonged-sitting-boosts-bad-health. Giving employees the option of a height-adjustable workstation would allow employees to sit or stand, at will, throughout the work day. This is a feasible, cost-effective way to improve employee health.

When almost every employee in a certain area has similar concerns with a particular manager, it usually goes unnoticed (more like ingnored) unless there's a "big stink" that causes higher management to pay attention. Allow the employees to have some impact on a manager's performance eval. Some managers may not realize how their employees view them, and they may not care until it actually has the potential to affect their evaluation...

The managerial attempts to improve the Agency's rating are futile. The only employees gullible enough to fall for this ridiculous facade are those who just began working here.

At the present time, the clearance process to submit a final report must go through a Rube Goldberg process that takes a week if not longer. Once the final draft is submitted, it goes through yet more reviews until the final final draft is submitted the MAC project officer

Ensure that individuals have essential knowledge, leadership, and "people" skills before promotion to management. Create quarterly evaluation process so that employees can give feedback on current managers without fear of consequences.

In 2010, this is the first year that the online application process to recieve the flu shot has been ineffective. Many employees have wasted 30-45 minutes each time an e-mail is sent indicating that the flu shot is available. The links are very easily over-burdened and it is extremely frustrating to sign up. This is no way to encourage a healthier agency. Please find a better system! This has not been an issue over the past 10 years. Looks like CMS made an online process change for the worst in 2010.

Training in public health for CMS employees will link what we do to the consumers, i.e., individuals using Medicare and Medicaid versus operating in isolation of our clients/customers.

Especially in high-risk areas (i.e. Miami and L.A) pre-pay reviews should become the standard. It would be time consuming and pricey for CMS to implement. However, the ROI would likely be remarkable as billions of dollars of fraud, waste and abuse would be saved (or never paid). There are far too many unscrupulous providers in certain areas of our country. Pre-payment reviews would not only save us from paying their fraudulant claims, it would also help us to identify and punish these individuals.

The current rating system limits management's ability to recognize efficient and effective contributions to the workplace. A division is only given a limited number of 'exceptional' rankings it may hand out which may overlook some employees deserving of that status. On the other hand, management does not always address below average or substandard work of employees which has a direct effect on morale (I work hard, but my co-worker does not-yet we still get the same paycheck!). This futher perpetuates the old adage of the 'typical government employee'. CMS is capable of so much more-let's begin making changes from within!

Implement an internal instant messaging system throughout CMS. By utilizing this technology a lot of time and resources could be saved that is otherwise taken up walking to peoples cubes, unnecessarily using e-mail server space for quick questions.