Federal Reports

The VA Office of Inspector General (OIG) conducted a healthcare inspection at the facility to evaluate allegations related to a thoracic surgeon’s surgical complications including patient deaths and misrepresentations of operative note documentation and the facility’s inappropriate reporting of the thoracic surgeon’s complication rate.The surgeon, board certified in thoracic and cardiac surgery, began clinical practice in 2009, started working at the facility in 2013 as a staff thoracic surgeon, and was selected to become Chief of Surgery in July 2014.On November 9, 2017, the OIG received a complaint about the surgeon’s competency and quality of care in five patient cases. The OIG consulted with a non-VA thoracic surgeon, who reviewed the care of the five patients as well as 19 patient cases from a previous OIG evaluation.The non-VA consultant identified quality of care concerns with 16 of the 24 patient cases. The facility completed external management reviews and found five cases of concern. In February 2019, the surgeon was reassigned to a nonclinical care setting. Veterans Health Administration (VHA) and Veterans Integrated Service Network leaders established a panel of VHA cardiothoracic surgeons who reviewed 22 of the 24 cases evaluated by the non-VA consultant as well as other, additional cases. In December 2019, the panel determined that the surgeon delivered thoracic surgical care within quality expectations and the surgeon resumed patient care.The OIG did not substantiate that the facility failed to appropriately report surgical errors and complications. The OIG made five recommendations to the Under Secretary for Health related to a thoracic specialty leader, operative documentation, the National Surgery Office’s surgery assessments, and peer review processes. The OIG made an additional five recommendations to the Facility Director related to operative documentation, professional communications, Surgical Work Group oversight, privileging, and institutional disclosures.

Marc Hoang, a Pharmacist based in West Covina, California, pleaded guilty in United States District Court, Central District of California, on October 26, 2020, to making a false statement related to a health care fraud investigation. Our investigation found that Hoang knowingly and willfully made a materially false and fraudulent statement on a Drug Enforcement Administration (DEA) form. Hoang submitted the form to the DEA to renew the controlled substances registration for his former pharmacy. On the form, Hoang represented that he was the person who distributed the controlled substances and was the officer and point of contact for the pharmacy, when in fact, he was not.In this same investigation, Navanjun Grewal, a Plastic and Reconstructive Surgeon based in Beverly Hills, California, pleaded guilty in United States District Court, Central District of California, on January 13, 2021, to making and using a false document and to obstruction of a federal audit. Our investigation found that Grewal created false and fraudulent patient files in response to an audit request regarding prescriptions for compounded medications that were submitted for reimbursement.Both defendants will be sentenced at a future date.

Under the home health prospective payment system (PPS), the Centers for Medicare & Medicaid Services pays home health agencies (HHAs) a standardized payment for each 60-day episode of care that a beneficiary receives. The PPS payment covers part-time or intermittent skilled nursing care and home health aide visits, therapy (physical, occupational, and speech-language pathology), medical social services, and medical supplies.Our prior audits of home health services identified significant overpayments to HHAs. These overpayments were largely the result of HHAs improperly billing for services to beneficiaries who were not confined to the home (homebound) or were not in need of skilled services.Our objective was to determine whether Southeastern Home Health Services (Southeastern) complied with Medicare requirements for billing home health services on selected types of claims.

What We Looked AtIn the last 5 years, fatalities in crashes involving large trucks or buses increased by 10.6 percent. As part of its mission, the Federal Motor Carrier Safety Administration (FMCSA) oversees its medical certification program and promotes safety through regulations, policies, and monitoring of certified medical examiners and driver examinations. In May 2014, FMCSA initiated the National Registry of Certified Medical Examiners (National Registry) to assist in verifying that medical examiners can effectively determine if interstate commercial drivers meet FMCSA’s physical qualification standards. We initiated this audit given the significant safety risk posed by drivers who do not meet physical qualification requirements. Our audit objectives were to evaluate FMCSA’s procedures for overseeing its medical certificate program. Specifically, we analyzed FMCSA’s procedures for (1) validating and maintaining data quality in the National Registry and (2) monitoring medical examiner eligibility and performance and reviewing driver examinations.What We FoundFMCSA’s ability to oversee whether drivers meet physical qualification standards to safely operate a commercial vehicle is limited because of a lengthy outage of the National Registry and a resulting backlog of driver examination reports that were not entered into the Registry. In addition, weaknesses associated with the accuracy and completeness of data in the National Registry limit the effectiveness of FMCSA’s oversight. Furthermore, FMCSA has not fully implemented requirements for random periodic monitoring of medical examiners’ eligibility and performance. While FMCSA has conducted initial certification reviews of medical examiners’ eligibility qualifications, the Agency is not yet conducting annual eligibility audits after initial certification. Without these oversight reviews, FMCSA may be missing fraud indicators or other risks that may require mitigation and has less assurance that drivers are physically qualified to safely operate a commercial vehicle.Our RecommendationsWe conducted our audit of FMCSA’s medical certification program during a transition period while the Agency is working to design and deploy a new National Registry. FMCSA concurred with our four recommendations to improve FMCSA’s oversight of its medical certification program once the Agency deploys its new National Registry.