Federal Reports

The VA Office of Inspector General (OIG) conducted a healthcare inspection to assess the validity of allegations regarding a delay in performing an appendectomy, that the delay was caused by inadequate resident oversight, and surgeons paid by the VA were unavailable because they were working for other institutions. The OIG substantiated a delay of approximately three hours occurred in performing an appendectomy. The OIG team determined the delay was due to another patient requiring surgery more urgently and poor communication. No adverse event occurred due to the delay. The facility’s practice for scheduling surgeries did not address communication among key staff during the multiple steps between identifying the need for surgery and the time of surgery. Opportunities existed for facility leaders to evaluate communication between residents and surgeons. The OIG did not substantiate that the appendectomy was delayed because of inadequate resident oversight. Staff interviews and electronic health records confirmed that general surgery attendings were available at all hours to provide resident supervision and discuss patients, and were present in the operating room during surgeries. The OIG team was unable to determine the availability of surgeons or if they were working at other institutions while paid by the VA. Discrepancies existed with general surgeons’ reported hours and timecards for May 2018. The facility indicated that they did not maintain documents detailing part-time physicians’ tours of duty. The Veterans Integrated Service Network Fiscal Quality Assurance Manager also conducted a review of part-time physician hours and determined the facility did not maintain appropriate documentation. The OIG made two recommendations related to evaluating the surgery scheduling processes, and ensuring the adequacy of documentation for part-time physicians’ tours of duty and responsibilities for time and attendance.

The objective was to determine whether local purchases and payments made at the Denver, CO, General Mail Facility Station for miscellaneous services were valid and properly supported and processed.

1n February 2016, the Inspector General for the Intelligence Community (ICIG), I. Charles McCullough, asked the DHS OlG to review a Presidential Policy Directive 19 ("PPD-19") complaint filed by [REDACTED], a former CIA employee. The OHS OIG accepted the request, and in August 2016, the DHS OIG determined that it would conduct a full Wbistleblower Retaliation Investigation.

We issued this to determine whether the Social Security Administration (SSA) correctly exempted Old-Age, Survivors and Disability Insurance (OASDI) benefits from the Windfall Elimination Provision (WEP). Specifically, we reviewed exemptions for (a) workers who had 30 or more years of coverage subject to Social Security earnings, (b) workers who were eligible for a pension before 1986, and (c) Federal employees under the mandatory coverage provision.

According to the Centers for Disease Control and Prevention (CDC), opioids were involved in more than 47,000 deaths in 2017, and opioid deaths were 6 times higher in 2017 than in 1999. CDC has awarded funding to States to address the nonmedical use of prescription drugs and to address opioid overdoses. We are conducting a series of reviews of States that have received CDC funding to enhance their prescription drug monitoring programs (PDMPs). We selected New York for review because it experienced a significant increase in the rate of drug overdose deaths during 2016 and 2017.

When Congress established average sales price (ASP) as the basis for Medicare Part B drug reimbursement, it also provided a mechanism for monitoring market prices and limiting potentially excessive payment amounts. The Social Security Act (the Act) mandates that OIG compare ASPs with average manufacturer prices (AMPs). If OIG finds that the ASP for a drug exceeds the AMP by a certain percentage (currently 5 percent), the Act directs the Secretary of Health and Human Services to substitute the ASP-based payment amount with a lower calculated rate. Through regulation, CMS outlined that it would make this substitution only if the ASP for a drug exceeded the AMP by 5 percent in the 2 previous quarters or 3 of the previous 4 quarters.