Federal Reports

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.

The inspection sought to determine whether the Federal Student Aid office (FSA) established performance measures and indicators for returning borrowers to repayment. We found that FSA needed to establish effective performance measures and indicators to evaluate its performance for returning borrowers to repayment. Although FSA and the Office of the Undersecretary established operational and strategic objectives and operational goals for returning borrowers to repayment, they were not written in specific and measurable terms. In addition, although FSA identified several data metrics as performance measures and indicators for returning borrowers to repayment, they did not include clearly defined targeted percentages, numerical values, milestones, or measurements. Without effective performance measures and indicators, FSA is unable to assess whether it has made progress toward achieving its goals and objectives or if adjustments are needed to improve its performance. Overall, the lack of effective performance measures and indicators may negatively impact FSA’s ability to effectively identify, analyze, and respond to risks related to returning borrowers to repayment.

The Inflation Reduction Act appropriated $500 million for NPS to hire employees in National Park System units or national historic or scenic trails.

The VA Office of Inspector General (OIG) conducted a select review of Veterans Health Administration’s (VHA's) implementation of the 2022 United States Department of Veterans Affairs Sustainability Plan, which describes priority actions for achieving federal environmental sustainability goals outlined in Executive Order 14057. The review consisted of three healthcare delivery objectives to estimate VHA’s progress toward environmental sustainability. Objective 1 broadly looked at VHA’s approach to implementing the plan; objective 2 focused on a foundational priority action to help VHA’s sustainability efforts; and objective 3 examined the sustainability of VHA’s healthcare activities by analyzing purchased inhalational anesthetics to determine their contribution to greenhouse gas emissions, waste stream processes and tracking, and ethylene oxide use for sterile processing.Although VHA has started planning and implementing environmental sustainability actions, the OIG identified areas that would benefit from further evaluation. Most facility leaders reported that Green Environment Management System program managers are responsible for leading the implementation of the sustainability plan but the corresponding national program office reported program manager workload capacity as a barrier. VA, inclusive of VHA, implemented training focused on climate change but did not “incorporate environmental stewardship values,” as the executive order required. VHA increased attention to the use of inhalational anesthetics and the impact on greenhouse gas emissions, but the long-term cumulative environmental impact of inhalational anesthetics warrants consideration of a comprehensive mitigation strategy. VHA tracks waste streams and diversion rates from landfill but prohibits repurposing single-use medical devices, which impedes improvement of diversion rates. VHA reported elimination of ethylene oxide usage in sterile processing for healthcare operations.The OIG made one recommendation to the Secretary of Veterans Affairs to incorporate required training content, and four recommendations to the Under Secretary for Health related to position responsibilities, training content, and sustainable health care practices.