Federal Reports

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The Veterans Benefits Administration (VBA) manages VA’s disability compensation program, which pays benefits based on a veteran's degree of disability, ranging from 0 to 100 percent. When veterans are found 100 percent disabled or unemployable due to service-connected disabilities, VBA must also consider whether veterans qualify for permanent and total (P&T) disability status. The VA Office of Inspector General (OIG) examined whether VBA staff cited adequate medical evidence demonstrating that veterans met statutory requirements for P&T status. The review team found that 61 percent of the decisions sampled did not cite adequate medical evidence, and about 15,100 veterans received P&T status without this evidence. As a result, VA may have improperly paid an estimated $38 million in additional benefits for P&T veterans for dental care, as well as education benefits and healthcare coverage for dependents between October 1, 2017, and December 31, 2019. The OIG further estimated that VA may improperly pay more than $84 million over the next five years for these benefits. The review team determined that VA’s adjudication procedures manual is inconsistent with the statute on P&T status. The statute requires decision makers to be “reasonably certain” that a total disability is likely to continue throughout a veteran’s lifetime, while the manual allows them to establish P&T status without using this standard. In addition, decision makers did not always explain the reasons why they established P&T status in the rating decisions as required. The OIG recommended that VBA ensure the adjudication procedures manual is reviewed and updated for consistency with statute; revise procedures to ensure staff support P&T status decisions by citing evidence; and revise the title and language used in the decisions to more clearly explain the establishment of P&T status. The OIG also recommended VBA provide staff with appropriate training on the updated procedures.

The U.S. Postal Service has a formal role in the federal National Response Framework, which guides the country’s response to disasters and emergencies like hurricanes, bioterrorism, pandemics and other incidents. The OIG examined how the Postal Service continues to support the American public during the ongoing COVID-19 pandemic, even as the outbreak affects postal operations. The Postal Service has delivered essential items like prescriptions, unemployment benefit and stimulus payments, personal protective equipment, and coronavirus test kits. The Postal Service also has provided a backbone for the surge in ecommerce as more consumers buy household goods online. Ensuring the continuation of mail service during this challenging time is helping to keep the American public stay safe, secure, and connected.

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 Birmingham VA Medical Center and multiple outpatient clinics in Alabama. The inspection covers key clinical and administrative processes that are associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; 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. At the time of this inspection, the medical center’s leaders had been working together for four days. Employee satisfaction scores were generally similar to or better than VHA averages. Selected patient experience scores generally reflected similar or lower ratings than the VHA average. The OIG’s review of the medical center’s accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risk factors. However, the OIG identified a repeat finding related to dirty floors in patient care areas. The executive leaders were extremely knowledgeable within their scopes of responsibilities about VHA data and/or system-level factors contributing to specific poorly performing Strategic Analytics for Improvement and Learning measures. The OIG issued 18 recommendations for improvement across seven areas: (1) Quality, Safety, and Value • Root cause analyses (2) Medical Staff Privileging • Professional practice evaluations • Provider exit review processes (3) Environment of Care • Cleanliness and infection prevention procedures • Patient health information protection (4) Medication Management • Aberrant behavior risk assessment • Concurrent opioid and benzodiazepine therapy • Urine drug testing • Informed consent (5) Mental Health • Suicide safety plans • Suicide prevention training (6) Women’s Health • Women’s health primary care providers (7) High-Risk Processes • Annual risk analysis

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 Central Alabama Veterans Health Care System and multiple outpatient clinics in Alabama and Georgia. The inspection covers key clinical and administrative processes associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; 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 executive leadership team had vacancies in four of the five key positions. The director, associate director for patient care services, and associate director roles had been vacant for at least six months; the chief of staff position had been vacant for two years. The Deputy Director was the only permanently-assigned leader. Employee satisfaction and patient experience survey scores were generally lower than VHA averages. Executive leaders were generally knowledgeable about facility Strategic Analytics for Improvement and Learning (SAIL) measures, but lacked understanding of Community Living Center SAIL measures. The OIG issued 30 recommendations for improvement in eight areas:(1) Quality, Safety, and Value • Peer review processes • Utilization management processes • Root cause analysis processes (2) Medical Staff Privileging • Professional practice evaluations • Provider exit reviews (3) Environment of Care • Environmental cleanliness (4) Medication Management • Behavior risk assessment • Concurrent therapy • Urine drug testing • Informed consent • Patient follow-up • Pain committee (5) Mental Health • Patient follow-up • Staff training (6) Care Coordination • Goals of care conversations (7) Women’s Health • Women Veterans Health Committee • Quality data monitoring (8) High-Risk Processes • Annual risk analysis • Airflow testing • Staff training

Our objective was to determine mailer compliance with Negotiated Service Agreement (NSA) provisions and evaluate the U.S. Postal Service’s oversight of NSA Contract #50593050. We selected the NSA based on the mailer’s 2019 volume and revenue.

Our objective was to assess the Social Security Administration's (SSA) actions to expand oversight of its hearing process after the Huntington fraud scheme, which involved an administrative law judge (ALJ).