Federal Reports

The objective of our inspection was to describe Federal Student Aid’s (FSA) control activities over institutional processes for completing verification and reporting verification results in accordance with Federal requirements.We found that FSA implemented control activities over institutional processes for completing verification procedures and reporting verification results. Specifically, we identified five significant control activities over these processes: (1) annual compliance audits, (2) program reviews, (3) W code reports, (4) management information system (MIS) reports, and (5) verification guidance.We found that FSA performed ongoing monitoring of the verification guidance control activity; but FSA did not monitor the other control activities on a regular basis. However, in September 2018, FSA’s Enterprise Risk Management (ERM) group issued a document titled “Verification Internal Review Report” (ERM Report) that described its separate evaluation of the processes FSA had in place to ensure institutions performed verification. We found that FSA did not address all of the control issues identified in the ERM Report and did not always determine the appropriate corrective actions or complete or document the corrective actions taken.

The VA Office of Inspector General (OIG) conducted a healthcare inspection at the Marion VA Medical Center in Illinois (facility) to review an allegation that a patient died due to complications from high cholesterol.The OIG substantiated that high cholesterol contributed to the patient’s death; however, the death certificate indicated that the primary cause of death was accidental acute multi-drug intoxication.The psychiatrist and staff failed to document providing the patient with education during a telephone encounter regarding potential side effects or adverse drug-drug interactions of medication changes.Contrary to clinical guidance, the psychiatrist prescribed long-term benzodiazepine use for a patient diagnosed with posttraumatic stress disorder. The psychiatrist also failed to address the patient’s two negative urine drug screens for a prescribed medication, and failed to address a positive urine drug screen for cannabis.Due to COVID-19, the facility failed to launch the Psychotropic Drug Safety Initiative Phase Four Plan.The primary care provider did not comply with facility policy by failing to enter a return-to-clinic order following an appointment but could not determine if this affected the patient. Primary care and behaviorial health staff did not comply with facility policy to telephone the patient or send a letter after the patient missed appointments.The OIG made five recommendations related to ensuring behavioral health staff provide and document patient education regarding possible side effects of medications and adverse drug-drug interactions; timely communicating test results; monitoring implementation of Phase Four of the Psychotropic Drug Safety Initiative; ensuring primary care staff comply with entering return-to-clinic orders; and ensuring primary care and behavioral health staff document contacts, attempted contacts, and letters sent when a patient misses an appointment.

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Why OIG Did This Audit A previous OIG review found that medical equipment suppliers could bill Medicare for a noninvasive home ventilator (NHV) as if it were being used as a ventilator, when use of a lower cost respiratory assist device or basic continuous positive airway pressure device was indicated by the patient’s medical condition.Sleep Management, LLC (Sleep Management), was among the top three suppliers of NHVs in calendar years (CYs) 2016 and 2017. Medicare paid Sleep Management $36.8 million for NHVs during our audit period. Our objective was to determine whether Medicare claims submitted by Sleep Management for the monthly rental of NHVs complied with Medicare requirements.How OIG Did This AuditWe selected a random sample of 100 claim lines for the monthly rental of NHVs submitted by Sleep Management that Medicare paid in CYs 2016 and 2017 (audit period). An independent medical review contractor reviewed supporting documentation to determine whether the claim lines complied with Medicare coverage and payment requirements.