Federal Reports

The Office of Inspector General (OIG) Care in the Community program evaluates selected performance elements of the Veterans Health Administration (VHA) Veterans Community Care Program. The resulting report describes selected care coordination activities required to initiate and process referrals for non-VA care (community care). The OIG reviewed community care processes in five VISN 9 medical facilities with a community care program from June 12 through July 13, 2023. The OIG evaluated the facilities’ processes for community care referral and care coordination in the following domains:
1. Leadership and Administration of Community Care
2. Community Care Diagnostic Imaging Results
3. Administratively Closed Community Care Consults
4. Community Care Provider Requests for Additional Services
5. Care Coordination: Scheduling and Communication with Veterans Referred for Community Care

The OIG issued 14 recommendations for improvement across all five domains as follows:
1. Leadership and Administration of Community Care
• Operating model staffing tool reassessment
• Patient safety event reporting
• Briefing the oversight council
• Document scanning
2. Community Care Diagnostic Imaging Results
• Diagnostic imaging result attachment to required note
• Significant findings alert use for abnormal results
3. Administratively Closed Community Care Consults
• Obtaining medical documentation
• Significant findings alert use when closing consults without documentation
4. Community Care Provider Requests for Additional Services
• Requests for services processing
5. Care Coordination: Scheduling and Communication with Veterans Referred for Community Care
• Level of care assignments
• Care coordination documentation
• Timely update of consult status to active
• Timely appointment scheduling
• Appointment attendance confirmation

Declining mail volume and a growing share of parcels in the mail mix have impacted the composition of the Postal Service’s workforce in recent years. Additionally, the U.S. labor market experienced dramatic swings, cratering in the early days of the COVID-19 pandemic, then tightening considerably as organizations struggled to recruit, hire, and retain employees.The USPS OIG found the Postal Service added 8,105 employees between FYs 2019 and 2023, a 1.3 percent increase over the 5-year period. In percentage terms, the number of mail handlers grew the most, increasing by 18.8 percent. Clerks rose by 1.9 percent, while the number of city carriers fell by less than half of one percent, rural carriers declined by 3.1 percent, and building and equipment maintenance employees fell by 6.1 percent.

This U.S. Small Business Administration Office of Inspector General (SBA OIG) report presents the results of our audit of the U.S. Small Business Administration’s (SBA) oversight of the Historically Underutilized Business Zone (HUBZone) program. The program provides small businesses that are located in economically distressed communities access to federal contracting opportunities to stimulate their local economies. In fiscal year (FY) 2022, SBA reported that federal agencies awarded over $16.3 billion, or 2.7 percent of prime federal contracting dollars, to 5,818 HUBZone businesses.We found SBA completed almost all 1,252 triennial program examinations timely and correctly validated 18 of the 20 firms we reviewed (90 percent) met eligibility requirements. Notwithstanding, we have identified some opportunities to further improve eligibility review practices and enhance functionality of the HUBZone information system that notifies participants of their annual recertification requirements.We made four recommendations for SBA to establish authoritative guidance for verifying that firms met eligibility requirements at the time of the triennial program examinations and improve system functionality for sending timely recertification notifications to all HUBZone firms. The agency partially agreed with three recommendations and disagreed with one.

The independent public accounting firm of Brown & Company CPAs and Management Consultants, PLLC, under contract with the Office of Inspector General, audited Help America Vote Act (HAVA) grants administered by the Michigan Department of State (MDOS), totaling $49.88 million. This included federal funds, state matching funds, and interest and program income earned on the reissued Section 101, reissued Section 251, Election Security, and Coronavirus Aid, Relief, and Economic Security (CARES) Act grants.

The Veterans Health Administration (VHA) purchases community healthcare services by contracting with third-party administrators (TPAs), which in turn contract with community providers. When prescribing drugs, community providers submit prescription requests to be filled at VA pharmacies and must consider VA’s approved formulary drugs before others, which require special authorization (usually a justification for its use). The VA Office of Inspector General (OIG) conducted this audit to determine if VHA’s oversight of TPAs ensured that community providers prescribed special-authorization drugs as required.The OIG determined that community providers rarely submitted initial prescriptions for special-authorization drugs with required justifications, partly because the electronic prescription system lacked the means to include justifications. VA pharmacies reported that ongoing staffing challenges and increased community care prescriptions required additional processing time and caused a backlog. However, VA pharmacies sometimes did not record receipt dates for these prescriptions accurately, which made it difficult for VHA to track delayed processing. The OIG found that community care prescription processing often exceeded VHA’s four-day standard, with an average of about 11 days for processing.These issues occurred partly because of ineffective oversight at multiple levels. VHA did not hold TPAs accountable for making certain that community providers followed formulary procedures for special-authorization drugs. Although TPAs developed formulary training, less than 2 percent of community providers completed it. The OIG questioned about $200.2 million in prescription costs that lacked justification from community providers.The OIG made seven recommendations to the under secretary for health to improve community providers’ compliance when prescribing special-authorization drugs, such as enhancing prescription system capabilities, addressing training requirements, improving VA pharmacies’ documentation of justifications, and clarifying requirements for VA pharmacies to report community providers that are not compliant.