Federal Reports

The VA Office of Inspector General (OIG) substantiated an allegation that the VA Southern Nevada Healthcare System’s (System) prosthetics laboratory did not provide timely and cost-effective services to veterans for frequently prescribed compression garments and orthotic shoes. The laboratory showed a needlessly high reliance on outside vendors from October 2014 to May 2016 for items that it could have provided from existing stock. About 99 percent of prescribed compression garments and 75 percent of orthotic shoes, accounting for 91 percent of the System’s spending, went to vendors during this period. Sending veterans to outside vendors was not justified because the System had sufficient personnel and inventory to provide the prescribed compression socks and orthotic shoes. The OIG found that poor decision-making by laboratory employees, underutilized laboratory personnel, and unused inventory went undetected because the former chief of prosthetics did not effectively monitor the laboratory’s operations. The OIG also found that purchasing employees reported some cases were being closed prematurely using an incorrect program code indicating the veteran did not follow through with the consult. The OIG expanded the scope of the audit and found that the code was used incorrectly about 95 percent of the time resulting in a risk of delayed care for veterans. Since the audit period, a new chief of prosthetics has implemented sweeping changes to the laboratory. As a result of the changes, reliance on outside vendors dropped to 14 percent after June 2016. The OIG recommended that the VA Southern Nevada Healthcare System continue to improve its oversight and use of resources in the laboratory. Because the System’s previous chief of prosthetics is currently serving as the chief of prosthetics for the VA San Diego Healthcare System, the report includes similar recommendations for that organization.

The opioid crisis was recently declared a public health emergency. In 2016, more than 42,000 opioid-related overdose deaths occurred in the United States-115 deaths per day. This data brief is part of a larger strategy by OIG to fight the opioid crisis and protect beneficiaries from prescription drug misuse and abuse. This data brief provides 2017 data on the extent to which Medicare Part D beneficiaries receive extreme amounts of opioids or appear to be doctor shopping and compares these data to OIG's previous analysis of 2016. It also identifies prescribers who have questionable opioid prescribing.

This toolkit provides detailed steps for using prescription drug claims data to analyze patients' opioid levels and identify certain patients who are at risk of opioid misuse or overdose. It is based on the methodology that OIG has developed in our extensive work on opioids.This new OIG product provides highly technical information to support our public and private sector partners, such as Medicare Part D plan sponsors, private health plans, and State Medicaid Fraud Control Units. It is intended to assist our partners with analyzing their own prescription drug claims data to help combat the opioid crisis.

Please click the link below to see a video and podcast related to this report.

The VA Office of Inspector General (OIG) conducted a risk assessment of the three types of charge cards used by VA—purchase cards (including convenience checks), travel cards, and fleet cards. Office of Management and Budget Memorandum M-13-21, Implementation of the Government Charge Card Abuse Prevention Act of 2012, requires Inspectors General to conduct annual risk assessments of illegal, improper, or erroneous purchases within charge card programs. Based on its risk assessment of VA’s fiscal year (FY) 2017 charge card transactions, the OIG determined that VA’s Purchase Card Program remains at medium risk of illegal, improper, or erroneous purchases. The data mining of purchase card transactions identified potential misuse of purchase cards, and OIG investigations, audits, and reviews continue to identify patterns of purchase card transactions that do not comply with the Federal Acquisition Regulation and VA policies and procedures. The VA Purchase Card Program is the largest VA charge card program, as measured by both the number of transactions and the amount of spending. Agency purchase card spending increased from about $4.1 billion in FY 2016 to about $4.2 billion in FY 2017. The OIG determined that VA’s Travel and Fleet Card Programs have a low risk level of illegal, improper, or erroneous purchases. The risk assessment team assigned a low risk level for these programs primarily because travel and fleet card transactions represented only about 3.1 percent and about 0.4 percent, respectively, of the approximately $4.4 billion VA spent on charge card transactions during FY 2017. The OIG continues to plan audits of VA’s charge card expenditures. The OIG Office of Investigations also continues to perform work on individual cases of purchase card abuse.________________________________________