Federal Reports

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the Chillicothe VA Medical Center and multiple outpatient clinics in Ohio. The inspection covers key clinical and administrative processes associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; COVID-19 Pandemic Readiness and Response; Quality, Safety, and Value; Medical Staff Privileging; Medication Management: Long-Term Opioid Therapy for Pain; Mental Health: Suicide Prevention Program; Care Coordination: Life-Sustaining Treatment Decisions; Women’s Health: Comprehensive Care; and High-Risk Processes: Reusable Medical Equipment.The medical center’s executive leadership team appeared stable. At the time of the virtual site visit, leaders had worked together for almost two months, while some had served in their roles for more than a year. Employee survey data revealed opportunities for the Chief of Staff to improve satisfaction in the workplace. Patients generally appeared happy with their care. The OIG’s review of the medical center’s accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risk factors. Executive leaders were able to speak in depth about actions taken during the previous 12 months to maintain or improve employee satisfaction and patient experiences. Leaders were knowledgeable within their scope of responsibilities about data and/or factors contributing to specific poorly performing Strategic Analytics for Improvement and Learning measures.The OIG issued 12 recommendations for improvement in six areas:(1) Quality, Safety, and Value• Peer review summary reports• Root cause analysis processes(2) Medical Staff Privileging• Ongoing professional practice evaluations• Provider exit review forms(3) Medication Management• Pain management committee processes(4) Mental Health• Suicide prevention training(5) Women’s Health• Women veterans health committee membership and attendance(6) High-Risk Processes• Standard operating procedures• Airflow directional devices• Staff training and competency

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements

Amtrak (the company) contracted with the independent public accounting firm of Ernst & Young LLP to audit its consolidated financial statements as of and for the fiscal year then ended, September 30, 2020, and to provide a report on internal control over financial reporting and compliance with certain provisions of laws, regulations, contracts and grant agreements, and other matters, which they issued on December 17, 2020.1 Because the company receives federal financial assistance, it must obtain an audit performed in accordance with U.S. generally accepted government auditing standards. The contract also required Ernst & Young to perform a Single Audit of the company’s federal financial assistance for the fiscal year ended September 30, 2020, in accordance with the audit requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). The objective of the Single Audit was to test internal control over compliance with major federal program award requirements and determine whether the company complied with the laws, regulations, and provisions of contracts or grant agreements that may have a direct and material effect on its major federal programs. As required by the Inspector General Act of 1978, we monitored the audit activities of Ernst & Young to help ensure audit quality and compliance with auditing standards. Our review disclosed no instances in which Ernst & Young did not comply, in all material respects, with U.S. generally accepted government auditing standards and Uniform Guidance requirements.

The objective of our audit was to determine whether Federal Student Aid (FSA) designed and implemented processes that provided reasonable assurance that it reallocated unexpended award year 2016–2017 campus-based student financial assistance program funds in accordance with the Hurricanes Harvey, Irma, and Maria Education Relief Act of 2017.First, FSA did not design and implement processes that provided reasonable assurance that it identified all schools participating in the campus-based student financial assistance programs that were affected by or enrolled students affected by a qualifying disaster before reallocating unexpended award year 2016–2017 FSEOG and FWS funds. Second, FSA did not design and implement processes that provided reasonable assurance that it would give preference to schools located in affected areas when reallocating FWS funds.