Federal Reports

The VA Office of Inspector General (OIG) conducted a national review of stat community care consults generated during the outset of the COVID-19 pandemic to evaluate consult processes. Patient involvement in care urgency disagreements and reporting of adverse events in community care were also reviewed. When the OIG identified deficiencies in processes, electronic health records (EHRs) of the patients at issue were further examined for potential negative outcomes. The OIG did not identify any negative care outcomes.For the 2,236 stat community care consults generated from March 20, 2020, through June 30, 2020, that were in an active, scheduled, or completed status, the OIG reviewed the community medical provider documentation contained in patients’ EHRs and determined the following:• Care was not provided within 24 hours for 379 (16.9 percent) consults.• Care was provided as requested for 2,049 consults (91.6 percent) irrespective of being within or outside of 24 hours.The OIG conducted an electronic survey regarding facility stat community care consult processes and identified:• Approximately 10 percent of facilities reported not processing stat consults in community care. Of these, almost three-fourths referenced difficulties meeting consult requirements, such as preauthorization of care, obtaining community provider medical documentation, and completing consults within 24 hours.• Of the facilities that responded, almost one-fourth indicated the chiefs of staff or designees changed the urgency statuses of consults from stat to routine without collaborating with the referring providers.The OIG made six recommendations to the Under Secretary for Health related to community care resources, facility practices, and VHA requirements that specifically focused on stat community care consults:• Retrieval of medical records and administrative closure• Urgency override process• Patient involvement in clinical decision-making regarding consult urgency status• Time frame for adjudicating clinical appeals• Adverse event–reporting processes

The Department of Homeland Security improved drug interdiction efforts with timely corrective actions in response to eight of our prior recommendations. Specifically, DHS improved maritime drug interdiction operations by enforcing and strengthening existing mechanisms to coordinate operations and improve oversight at the field and Department levels.

What We Looked AtAs part of its mission to prevent and reduce vehicle crashes, the National Highway Traffic Safety Administration’s (NHTSA) Office of Safety Compliance (OVSC) sets Federal Motor Vehicle Safety Standards (FMVSS) to improve traffic safety. FMVSS provide performance and regulatory requirements for manufacturers of motor vehicles and vehicle safety components, such as seatbelts. Given the importance to the traveling public that all vehicles and components meet Federal safety standards, we initiated this audit to assess NHTSA’s efforts to set and enforce FMVSS. What We FoundWhile NHTSA has established policies and procedures for evaluating FMVSS and safety-related motor vehicle standards, the Agency is limited in its ability to update, set, and enforce these standards in a timely manner. First, NHTSA has faced significant delays in processing rulemaking petitions to modify or set new FMVSS, which may put the Agency in noncompliance with Federal regulations. For example, the Agency did not respond within the required 120-day timeline to 87.5 percent of FMVSS petitions submitted between March 2016 and December 2020. Second, NHTSA lacks formal training and clear guidance for enforcing compliance with FMVSS. For example, NHTSA’s OVSC lacks documented standard procedures and training for reviewing contractors’ compliance test reports and has not implemented guidance for conducting compliance investigations. Third, NHTSA is not meeting requirements for ensuring imported vehicles meet FMVSS. NHTSA’s OVSC requires Registered Importers to submit conformity packages detailing safety modifications made to comply with FMVSS. However, NHTSA lacks a standard process for reviewing these packages, increasing the risk of unsafe vehicles operating on U.S. roads. Our RecommendationsNHTSA concurred with our six recommendations to strengthen its oversight of FMVSS to comply with Federal requirements. We consider recommendations 1 through 6 resolved but open pending completion of planned actions.

OIG audited the consolidated financial statements of Rural Development for fiscal years 2021 and 2020.

The Federal Managers’ Financial Integrity Act of 1982 (FMFIA), P.L. 97-255, as well as the Office of Management and Budget’s (OMB) Circular A-123, Management’s Responsibility for Enterprise Risk Management and Internal Control, M-16-17 establish specific requirements for management control. Each executive agency must establish controls to reasonably ensure that: (1) obligations and costs are in compliance with applicable laws; (2) funds, property and other assets are safeguarded against waste, loss, unauthorized use, or misappropriation; and (3) revenues and expenditures applicable to agency operations are properly recorded and accounted for to permit the preparation of reliable accounts and financial and statistical reports, and to maintain accountability over the assets. FMFIA further requires the head of each executive agency, on the basis of an evaluation conducted in accordance with applicable guidelines, to prepare and submit a signed statement to the President and the Congress disclosing whether the agency’s system of internal accounting and administrative control fully complies with requirements established in FMFIA.

The OIG’s administrative investigation examined whether the deputy executive director of VA’s Office of Construction and Facilities Management (OCFM), during his tenure as acting executive director, failed to respond appropriately to a 2018 audit by the office’s Quality Assurance Service (QAS). The QAS audit found that an unsubstantiated assertion was used to justify a lease acquisition by OCFM’s Central Region Office. The audit was deemed a “special review,” for which the service lacks a governing policy. Consequently, there was no process to track the audit’s findings and recommendations, unlike routine compliance reviews. The deputy executive director took 11 months to respond to the audit and did so only to OCFM’s executive leadership, leaving some OCFM personnel with an impression that he had ignored it. Although the OIG did not find that the deputy executive director failed to respond to the audit, it determined that OCFM lacks a policy relating to special reviews and made a corresponding recommendation.The OIG also investigated whether the deputy executive director, while the acting executive director, falsely attested to the effectiveness of OCFM’s internal controls. The deputy executive director signed statements of assurance in 2019 per governing requirements, attesting that OCFM’s controls suffered from no material weaknesses. At a February 2020 meeting, he commented on concerns he had with OCFM’s controls and assessment process, which some attendees viewed as an admission of a past false statement. The deputy executive director’s interview responses, his contemporaneous statements, and an informal inquiry by his successor indicated that the February 2020 comments referred merely to nonmaterial weaknesses in OCFM’s controls and assessment process. Thus, the OIG did not substantiate that the deputy executive director made false statements.VA concurred with the OIG’s findings and its recommendation.