Federal Reports

The OIG conducted this audit to determine whether VHA national program offices provided effective oversight of contracted community-based outpatient clinics (CBOCs). The audit team found the offices did not effectively oversee contracted CBOCs because oversight ended after vendors were awarded contracts to acquire, furnish, and run the clinics. This left VHA without national oversight of the effectiveness of the contracts. VHA’s policies governing contracts for CBOCs did not incorporate all responsibilities required of a VHA program office: identifying emerging national issues, communicating with internal and external stakeholders, managing quality and compliance, and evaluating program effectiveness and efficiency. The policy omissions limited program offices’ ability to identify and implement solutions for national issues, such as contractors not meeting performance metrics, start-up (construction) costs keeping small businesses from competing for contracts, staff having to manually create patient rosters (monthly lists of patients for which contractors can invoice VA), and medical centers (which were supposed to oversee CBOC operations) not appointing adequately certified contract monitors. The problems the OIG audit team documented may have adversely affected care provided to veterans—sampled CBOCs provided healthcare services that scored below VHA’s overall performance metrics—and created administrative challenges for VA medical centers and contracting offices.

The audit team also found that, contrary to federal acquisition requirements, contract templates did not give contracting officers the option to include performance incentives. Without effective means to hold contractors accountable for performance, the contracting officers and VA medical centers accepted and paid in full for services that did not meet requirements.

The OIG made 12 recommendations, including to delegate program office oversight responsibilities, monitor contractor compliance with the contracts, develop consistent procedures for patient rosters, and work with the VA Office of General Counsel on start-up costs and incentives.

This audit was performed by the Defense Contract Audit Agency (DCAA) on behalf of the Department of Energy’s Office of Inspector General, which examined Fermi Research Alliance, LLC’s costs incurred and claimed for fiscal years 2021 and 2022 at the Fermi National Accelerator Laboratory, under management and operating contract No. DE-AC02-07CH11359.

The audit’s objective was to determine if costs charged to Department Contract No. DE-AC02-07CH11359 for fiscal years 2021 and 2022 were allowable, allocable, and reasonable in accordance with applicable laws, regulations, and contract terms.

The DCAA performed the audit in accordance with generally accepted government auditing standards.

The DCAA identified two audit findings and questioned approximately $9.9 million in performance award fees and $142,463 in direct costs. Specifically, the DCAA questioned performance award fees in the General and Administrative pool. The DCAA questioned the performance award fees, which represented a contractual incentive paid by the Department because the fee was included as a cost in the General and Administrative pool. The DCAA reconciled the proposed fee amount to the general ledger, and the Department determined that the contractor was entitled to the earned fee. The DCAA also questioned labor costs due to claimed triple-time pay for employees working on holidays, which exceeded allowable pay of double-time. In addition to the questioned costs noted, the DCAA reported two scope limitations because real-time testing was not performed, which resulted in unresolved risk that could materially affect: (1) labor costs and (2) direct materials and supplies costs.  

If the issues identified by the DCAA are fully addressed, it should help ensure that costs charged to the Department are allowable, allocable, and reasonable in accordance with contract terms. We recommend that the contractor coordinate with the contracting officer to resolve the questioned costs identified in this report.

This audit was performed by the Defense Contract Audit Agency (DCAA) on behalf of the Department of Energy’s Office of Inspector General and examined Jefferson Science Associates, LLC’s (JSA) costs incurred and claimed for fiscal years 2022 and 2023 at the Thomas Jefferson National Accelerator Facility, under management and operating contract No. DE-AC05-06OR23177.

The audit’s objective was to determine if costs charged were allowable, allocable, and reasonable in accordance with applicable laws, regulations, and contract terms.

The DCAA performed the audit in accordance with generally accepted government auditing standards.  

The DCAA identified one audit finding and questioned approximately $6.3 million in performance award fees included in the General and Administrative pool. The performance fees represented a contractual incentive paid by the Department and were questioned by the DCAA because JSA included the fee as a cost in the General and Administrative pool. The DCAA reconciled the proposed fee amount to performance evaluation reports, and the Department determined that the contractor was entitled to the earned fee.

If the issue identified by the DCAA are fully addressed, it should help ensure that costs charged to the Department are allowable, allocable, and reasonable in accordance with contract terms. We recommend that the contractor coordinate with the contracting officer to resolve the questioned costs identified in this report.

The Udall Foundation did not adhere to NIST standards, hindering its ability to devise a viable approach for managing its information security risks.

The VA Office of Inspector General (OIG) initiated a healthcare inspection at the Richard L. Roudebush VA Medical Center (facility) in Indianapolis, Indiana, to assess allegations and concerns related to the availability of on-call interventional radiology services. In May 2024, VA clarified that fee basis provider duties must be related to direct patient care activities, which prevented VA from paying providers for being on call and available to provide patient care services. In response, the facility halted on-call interventional radiology services, which were later resumed intermittently using facility providers.  

The OIG did not substantiate the allegation that a waiver request should have been submitted prior to the reduction in coverage. However, the OIG substantiated that confusion and deficient communication of intermittent on-call coverage led to a patient being unnecessarily transferred after developing a gastrointestinal bleed, despite services being available at the facility. The resumption of coverage on an intermittent basis was communicated to staff and leaders through emails and daily calls. However, the patient’s intensive care unit (ICU) attending physician and the ICU director were not included in the email communication and did not participate in the daily calls. Further, the ICU fellow who transferred the patient did not consult with the ICU attending physician and the gastroenterology fellow did not document assessing the patient as required. 

The OIG determined that a clinical or institutional disclosure was not conducted, facility leaders did not conduct a comprehensive review of the event to understand staff’s involvement, and quality management staff did not process a related patient safety report in accordance with VHA policy.

The Facility Director concurred with the six recommendations and shared plans and actions taken to address communication, documentation, disclosure, patient safety reporting, mitigation of risks that contributed to the transfer, and rejected patient safety reports.