Federal Reports

In this legislatively mandated review, the OIG sought to determine whether VBA continues to use updated public disability benefits questionnaires and, because public questionnaires may pose a significant risk of fraud without adequate internal controls, to examine VBA’s oversight of their use. Publicly available questionnaires are to be completed by veterans’ non-VA medical providers, whereas internal questionnaires are completed by VA medical providers.The OIG team reviewed a sample of 100 claims for benefits completed from January 1 through December 31, 2022, supported by at least one public questionnaire. These 100 claims contained 207 public questionnaires because some claims had more than one questionnaire submitted. The team developed its own indicators of fraud risk because VBA lacked them.The team found that VBA generally accepted and used public questionnaires when determining entitlement to benefits. However, VBA does not have effective controls to mitigate the risk of using fraudulent forms to decide benefits. On the basis of its sample, the team estimated that of the 31,900 claims completed during the review period, approximately 22,000 claims (69 percent) had one or more fraud risk indicators. Although public questionnaires with fraud risk indicators show only possible instances of fraud, the team’s projections suggest that the monetary risk to VA could be approximately $390 million.The OIG made five recommendations to the under secretary for benefits, chief among them to continue developing a system for digitally capturing, analyzing, and monitoring public questionnaires to identify inauthentic or fraudulent questionnaires, and work with the Compensation Service to develop policies for reviewing and remediating any such public questionnaires identified. Other recommendations were to have outside providers certify that they completed the questionnaires under penalty of perjury, and to enhance guidance and training for claims processors.

An Amtrak Senior manager based in Philadelphia was terminated from employment on December 8, 2023, as the result of our investigation that found he submitted falsified applications to the Small Business Administration for a Coronavirus Aid, Relief, and Economic Security Act Economic Injury Disaster Loan. In addition, the former employee signed a civil settlement agreement with the U.S. Attorney’s Office, Middle District of Florida, and agreed to pay $25,441 in restitution related to the fraudulent loan.

The OIG reviewed the Veterans Health Administration’s (VHA’s) assessment and management of inpatient alcohol withdrawal following several OIG inspections where adverse clinical outcomes associated with alcohol withdrawal, likely contributing to patient deaths, were identified. Determining the severity of alcohol withdrawal is critical in facilitating treatment decisions that may prevent the progression of symptoms which could be fatal.Inpatient management of alcohol withdrawal is not specifically addressed in current VHA clinical guidance, and it does not fall under one VHA national program office. The OIG evaluated national and system-level written guidance for specificity to inpatient management of alcohol withdrawal in four key areas: determination of alcohol withdrawal severity, inpatient treatment of alcohol withdrawal, inpatient staff training for assessing alcohol withdrawal severity, and oversight for inpatient management of alcohol withdrawal (guidance and monitoring).The OIG found healthcare systems lacked written guidance related to assessing and reassessing alcohol withdrawal severity; determining the appropriate inpatient level of care; evaluating co-occurring conditions; consulting with substance use disorder experts; and pharmacotherapy. Written guidance was also lacking for when nurses should consult prescribers based on patients' alcohol withdrawal severity, when prescribers should evaluate patients face-to-face based on nursing assessment findings, and when to transfer care.Written guidance for inpatient management of alcohol withdrawal could decrease the risk of adverse patient safety outcomes and, along with training, facilitate knowledge of proper administration and consistency of assessments. Detailed expectations for oversight and monitoring would allow for quality of care to be evaluated and assessed for compliance with available substance use disorder guidance.The OIG made three recommendations to the Under Secretary for Health related to consideration of identifying a national office responsible for oversight, implementing written guidance for the management of alcohol withdrawal across inpatient settings, and implementing inpatient staff training on standardized alcohol withdrawal severity scales.