Federal Reports

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the leadership performance and oversight by Veterans Integrated Service Network (VISN) 10: VA Healthcare System Serving Ohio, Indiana and Michigan in Cincinnati, covering leadership and organizational risks and key processes associated with promoting quality care. This inspection focused on COVID-19 Pandemic Readiness and Response; Quality, Safety, and Value; Medical Staff Credentialing; Environment of Care; Medication Management: Long-Term Opioid Therapy for Pain; Women’s Health: Comprehensive Care; and High-Risk Processes: Reusable Medical Equipment. The OIG conducted this virtual site visit during concurrent reviews of VISN 10 facilities.Executive leaders had worked as a team for three months at the time of the OIG’s virtual site visit. Employee satisfaction survey score were higher than Veterans Health Administration (VHA) averages. Patient experience survey scores were similar to or higher than VHA averages. VISN leaders had an opportunity to reduce wait times and clinical vacancies.Leaders seemed to support efforts to improve and maintain patient safety, quality care, and other positive outcomes. They were also knowledgeable within their scope of responsibilities about selected Strategic Analytics for Improvement and Learning metrics and should continue to take actions to sustain and improve performance.The OIG issued seven recommendations for improvement in three areas:(1) Medical Staff Credentialing• Documented review of physician credentialing files prior to VA appointment(2) Women’s Health• Appointment of a VISN lead women veterans program manager• Quarterly program updates to executive leaders• Annual site visits at each facility(3) High-Risk Processes• VISN-led facility reusable medical equipment inspection results• Electronic posting of inspection results• VISN oversight of facility corrective action plan development and action item tracking

We did not substantiate allegations that the National Park Service improperly hired a senior political employee.

During research we found the 1915(c) Community Integration and Habilitation Waiver (CIH Waiver) services that Indiana reported on the Form CMS-64 accounted for just over $1.1 billion in Medicaid expenditures during Federal fiscal years (FFYs) 2015 and 2016. These expenditures represented approximately 5.9 percent of the total Medicaid expenditures reported on the Form CMS-64 during this period. We decided to perform this audit of the CIH Waiver services because of the significant dollar expenditures. Our objective was to determine whether Indiana ensured that CIH Waiver services at 12 selected providers were provided in accordance with Federal, State, and waiver requirements.

This audit is part of a series of hospital compliance audits. Using computer matching, data mining, and data analysis techniques, we identified hospital claims that were at risk for noncompliance with Medicare billing requirements. For calendar year 2018, Medicare paid hospitals $179 billion, which represents 47 percent of all fee-for-service payments for the year.Our objective was to determine whether Lake Hospital System (the Hospital) complied with Medicare requirements for billing inpatient and outpatient services on selected types of claims.