Federal Reports

This Comprehensive Healthcare Inspection Program provides a focused evaluation of the quality of care delivered at the Charlie Norwood VA Medical Center, covering leadership, organizational risks, and key processes associated with promoting quality care. Focused areas were Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; Medication Management: Controlled Substances Inspections; Mental Health: Military Sexual Trauma Care; Geriatric Care: Antidepressant Use among the Elderly; Women’s Health: Abnormal Cervical Pathology Results; and High-Risk Processes: Emergency Department/Urgent Care Center Operations. The facility’s leaders had been working together since December 2018, have opportunities to improve employee satisfaction and patient experiences, and supported efforts related to safety and quality care. However, the OIG had concerns regarding surgical procedure sentinel events and the lack of a process to capture, track, and trend patient safety indicator data. The leaders were aware of Strategic Analytics for Improvement and Learning (SAIL) metrics but should take actions to improve performance contributing to the facility’s SAIL “2-star” quality ratings. The OIG issued 24 recommendations for improvement: (1) Quality, Safety, and Value • Timely completion, improvement action implementation, and quarterly review of peer reviews • Interdisciplinary utilization management data reviews (2) Medical Staff Privileging • Focused and ongoing professional practice evaluation processes (3) Environment of Care • General safety and cleanliness • Inventory of assets and resources • Review of comprehensive emergency operations plan (4) Medication Management • Leadership oversight of controlled substances summary of findings and trends • Inspectors’ annual competency assessments • Monthly physical inventories • Reconciliation of dispensing and return of stock • Verification of orders, drugs held for destruction, prescription pads, hard copy prescriptions, and 72-hour inventory (5) Mental Health • Military sexual trauma training (6) Women’s Health • Women Veterans Health Committee membership and meetings • Cervical cancer screening data tracking/follow-up • Patient notification of abnormal results (7) Emergency Departments and Urgent Care Center Operations • Backup call schedule

The Southgate, MI, Post Office is in the Detroit District of the Great Lakes Area. Employees use Account Identifier Code (AIC) 526, Refund Spoiled/Unused Customer Meter Stamps, to record refunds of spoiled/unused postage meter stamps from customer postage meters. OIG data analytics identified the Southgate, MI, Post Office with $125,012, or a 324 percent increase, in refunds from April 1 through August 31, 2019, compared to April 1 to August 31, 2018.The spoiled and unused customer meter stamp refunds for the Southgate Post Office were 61 percent of the overall amount of refunds in the Detroit District for the same timeframe. This percentage ranked the highest in the Detroit District. Our objective was to determine whether meter refunds were properly issued, supported, and processed.

Except for identified questioned costs, reported DHS Purchase and Travel Card transactions for FY 2017 were appropriate and complied with relevant laws and regulations. The auditor, CohnReznick LLP, identified 17 control deficiencies within DHS Purchase and Travel Card Programs related to maintenance of purchase documentation, application of required procurement policies, price reasonableness determinations, price quotes/competitive bids, required sourcing, tax exemptions, and split purchases. The DHS Travel Card Program deficiencies related to maintenance of travel documentation, allowability of transactions per regulations, credit balance refunds, the prudent traveler standard, and improper use of a travel card. The auditor identified $43,508 in questioned costs for FY 2017 and made 12 recommendations. When implemented, these recommendations should ensure that Purchase and Travel Card transactions are appropriate and comply with relevant laws and regulations. The Office of the Chief Financial Officer concurred with six recommendations and non-concurred with six recommendations.

From fiscal years 2015 through 2018, in the midst of a growing opioid epidemic, U.S. Customs and Border Protection (CBP), U.S. Immigration and Customs Enforcement, Transportation Security Administration, and U.S. Secret Service appropriately disciplined employees whose drug test results indicated illegal opioid use, based on their employee standards of conduct and tables of offenses and penalties. Additionally, during the same time period, components have either implemented or are taking steps to evaluate whether employees using prescription opioids can effectively conduct their duties. For example, components have established policies prohibiting the use of prescription opioids that may impact an employee’s ability to work, in addition to requiring employees to report such prescription opioid use. They have also implemented or are in the process of implementing measures to evaluate the fitness for duty of employees using prescription opioids. These policies establish consistent standards components can use to ensure they are allowing employees to use legally-prescribed opioids, while also ensuring their workforce is capable of effectively performing their duties. We made two recommendations to improve components’ oversight of illegal and prescription opioid use by employees. CBP and Secret Service concurred with the recommendations, which are both resolved and open.

At CMS's request, the U.S. Department of Health and Human Services, Office of Inspector General (OIG), Office of Audit Services, Region VII pension audit team reviews the cost elements related to nonqualified plans and any other pension-related cost elements claimed by Medicare contractors through Final Administrative Cost Proposals (FACPs).

The Centers for Medicare & Medicaid Services (CMS) reimburses a portion of its contractors' nonqualified plan (nonqualified) costs.At CMS's request, the U.S. Department of Health and Human Services, Office of Inspector General (OIG), Office of Audit Services, Region VII pension audit team reviews the cost elements related to nonqualified plans and any other pension-related cost elements claimed by Medicare contractors through Incurred Cost Proposals (ICPs).

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements