Federal Reports

As part of our annual audit plan, we performed an audit of costs billed to the Tennessee Valley Authority (TVA) by Baker's Construction Services, Inc. (BCS) for field labor support services provided for TVA's civil construction organization under Contract No. 14743. Our audit objective was to determine if costs were billed in compliance with the contract's terms. Our audit scope included about $19.26 million in costs billed to TVA from January 1, 2020, through August 31, 2021.In summary, we determined BCS billed TVA:From $116,763 to $421,683 in unapproved temporary living allowance (TLA) costs. In addition, we identified other areas where the administration of TLA and TLA certifications could be improved.$44,941 in other ineligible and unsupported costs, including (1) $21,582 for ineligible and unapproved subcontractor costs, (2) $11,269 for ineligible equipment costs, <br> (3) $8,845 for duplicate and ineligible material costs, and (4) $3,245 for unsupported noncraft labor costs. We also noted opportunities to improve contract administration by TVA. Specifically, (1) the contract contained inconsistent language related to compensating noncraft labor, and <br> (2) several invoice and payment errors resulted in incorrect payments by TVA, which could have been identified with a proper invoice review.(Summary Only)

The VA Office of Inspector General (OIG) evaluated allegations that a primary care provider did not timely identify a liver abnormality nor inform a patient about a terminal cancer diagnosis at Overton Brooks VA Medical Center (facility) in Shreveport, Louisiana. The OIG identified additional concerns related to care coordination, resident supervision, communication of abnormal results, surrogate provider coverage, and patient safety event reporting.In early 2019, a primary care provider referred the patient to the facility’s Emergency Department for evaluation of leg pain. The patient was admitted and had imaging tests that showed a liver lesion with further testing recommended. The inpatient medicine provider (resident) included the imaging results in the patient’s progress note; however, the resident did not document findings or follow-up needs in the patient’s discharge summary. During four subsequent visits, the primary care provider’s notes lacked documentation of the lesion and recommended follow-up. In summer 2019, the patient reported having imaging at a community hospital that identified a liver tumor, and the primary care provider ordered a liver scan. The scan showed a liver mass and lesion. The primary care provider was on leave during the time the scan was conducted and an Emergency Department physician assistant was assigned as a surrogate for coverage. The OIG found no documentation that the primary care provider or the surrogate informed the patient of the abnormal findings.The patient died in fall 2019, after a confirmed liver cancer diagnosis.Facility leaders and staff did not take timely administrative action in response to the patient’s adverse event. Staff did not initiate a patient safety report and review the episode of care and the issues related to coordination of care.The OIG made four recommendations related to communication of abnormal test results, resident supervision, provider surrogate assignments, and patient safety reporting.

We contracted with the independent public accounting firm Williams, Adley & Company – DC, LLP (Williams Adley) to review CBP’s Drug Control Budget Formulation Compliance Report. Williams Adley is responsible for the attached Independent Accountant’s Report, dated January 20, 2023, and the conclusions expressed in it. Williams Adley’s report contains no recommendations.

This letter responds to the Government Charge Card Abuse Prevention Act of 2012 (Charge Card Act) reporting requirement for the Federal Trade Commission (FTC) for fiscal year 2023.

What We Looked AtThis report presents the results of our quality control review (QCR) of Allmond & Company, LLC’s (Allmond) management letter regarding the audit conducted, under contract with us, of the Surface Transportation Board’s (STB) financial statements as of and for the fiscal years ended September 30, 2022, and September 30, 2021. The management letter discusses internal control matters that Allmond was not required to include in its report on the audit of STB’s financial statements. What We FoundOur QCR of the management letter disclosed no instances in which Allmond did not comply, in all material respects, with generally accepted Government auditing standards. RecommendationsAllmond made six recommendations in its management letter. STB concurred with all six recommendations.