Federal Reports

In 2020, the Veterans Benefits Administration (VBA) processed about 1.2 million disability compensation claims and paid more than $90.8 billion in total benefits to veterans. About five million veterans were receiving these benefits as of December 31. To ensure claims decisions are accurate and consistent so veterans receive the benefits to which they are entitled, VBA established a multifaceted quality assurance program.The VA Office of Inspector General (OIG) reviewed the quality assurance program and identified a systemic weakness in oversight and accountability. In the quality assurance program, Compensation Service conducts reviews that identify deficiencies in the disability compensation benefits claims process, and the Office of Field Operations has oversight responsibility for ensuring regional office employees and supervisors follow quality assurance procedures and take action to correct deficiencies identified during quality assurance reviews. The OIG found that while VBA’s quality assurance program routinely identified claims-processing deficiencies and communicated results to internal and external stakeholders, the Office of Field Operations did not ensure that regional office employees took adequate corrective actions to address the deficiencies identified.Until VBA senior leaders ensure improvements are made, veterans are at risk of not receiving the benefits they deserve. The OIG recommended the acting under secretary for benefits develop and implement a written plan to strengthen oversight of the quality assurance program and monitor the plan to ensure identified deficiencies are adequately addressed.

The VA Office of Inspector General (OIG) conducted an inspection in response to allegations related to ophthalmology resident supervision and quality of care by an attending ophthalmologist (subject ophthalmologist) at the Oklahoma City VA Health Care System in Oklahoma.The OIG substantiated that the subject ophthalmologist failed to provide adequate resident supervision and entered inaccurate documentation related to supervision for a single patient case. The ophthalmology residents were unable to reach the subject ophthalmologist when the patient experienced a complication during an eye injection procedure. The residents reached another attending ophthalmologist who examined the patient and assisted the residents.The subject ophthalmologist was assigned to supervise residents in the clinic and did not arrange a hand-off for attending coverage when away from the clinic.The OIG found that a note in the patient’s electronic health record that documented supervision by the subject ophthalmologist was incorrect because the subject ophthalmologist did not directly participate in and was not present during the care of the patient. The subject ophthalmologist used a standard template and acknowledged the note was incorrect due to a failure to read and edit the note before signing it.Aside from the single patient case, the OIG did not identify other failures to supervise residents or inaccurate documentation of resident supervision by the subject ophthalmologist.The subject ophthalmologist, aside from the single patient case, provided and documented proper patient care. A review of 20 patients performed by an external ophthalmologist and the OIG determined the subject ophthalmologist provided acceptable quality of care and appropriate documentation.The OIG made three recommendations to the Facility Director related to documentation of resident supervision and the hand-off process for attending ophthalmologist coverage.

The Office of Inspector General evaluated the Agency’s fiscal year 2020 compliance with the Payment Integrity Information Act

The NASA Office of Inspector General reviewed the Agency’s cybersecurity readiness.

BACKGROUNDThe Temporary Assistance for Needy Families ProgramThe Personal Responsibility and Work Opportunity Reconciliation Act of 1996 established the TANF program to help families progress from welfare to self-sufficiency. Under TANF, the Federal government provides States $16.6 billion in annual block grants to design and operate programs that accomplish the TANF program’s four purposes. States have broad flexibility in how they spend their TANF and MOE funds. At the Federal level, ACF’s Office of Family Assistance administers the TANF program and provides oversight for compliance with Federal requirements. Federal Requirements States may use Federal TANF funds for expenditures that are reasonably calculated to accomplish the purposes of the TANF program or for which the State was authorized to use funds under prior law (45 CFR § 263.11). TANF and MOE expenditures must be necessary, reasonable, and allocable to the performance of the TANF program and be adequately documented (45 CFR §§ 75.403(a) and (g)). States must also submit quarterly reports of TANF data and financial information to ACF using the ACF-196R (Social Security Act § 411 and 45 CFR § 265.3). States’ quarterly ACF-196R reports must be complete and accurate and filed by the due date. States must maintain records to adequately support any report (45 CFR § 265.7). States’ financial management systems must be sufficient to permit the tracing of funds to a level of expenditures adequate to establish that such funds have been used according to the Federal statutes, regulations, and the terms and conditions of the Federal award. The financial management system must provide accurate, current, and complete disclosure of the financial results of each Federal award or program; maintain records that identify adequately the source and application of funds for federally-funded activities; and have effective control over, and accountability for, all funds, property, and other assets (45 CFR § 75.302). New York’s Temporary Assistance for Needy Families Program Expenditures In New York, the State agency administers the TANF program and delegates local social services districts (local districts) to operate their local program. For FY 2016, ACF awarded the State agency $2.7billion in Federal TANF funds and the State agency reported a total of $5.3 billion in TANF and MOE expenditures on its ACF-196R reports. These expenditures included $4.8 billion in total assistance payments and support expenditures for TANF-eligible families and individuals and $558 million transferred to two other ACF-funded programs—the Child Care and Development Fund (CCDF) and the Social Services Block Grant (SSBG) programs. The State agency obtained total TANF and MOE expenditures from local districts and TANF-funded State programs and reported these amounts on its ACF-196R reports. Local districts were responsible for collecting and maintaining supporting documentation for assistance payments and support services reported as TANF and MOE expenditures and submitted monthly summary reports of these expenditures to the State agency. On a quarterly basis, the State agency used summary reports submitted by the local districts to the State agency’s claims reporting system, gathered data from several schedules in these summary reports, and used a preset formula to calculate totals for both TANF and MOE expenditures. The State agency then combined these totals with monthly or quarterly expenditure totals from TANF-funded State programs, including program administrative expenditures, and reported its total quarterly TANF and MOE expenditure amounts to ACF on the ACF-196R. OBJECTIVEOur objective was to determine whether the New York State Office of Temporary and Disability Assistance (the State agency) ensured that its TANF and MOE expenditures reported to ACF met Federal requirements.

Our audit covered 21,537 claims for which Franciscan (located in University Place, Washington) received Medicare reimbursement of $101.5 million for hospice services provided from January 1, 2016, through December 31, 2017. We reviewed a random sample of 100 claims. We evaluated compliance with selected Medicare billing requirements and submitted these sampled claims and the associated medical records to an independent medical review contractor to determine whether the services met coverage, medical necessity, and coding requirements.