Federal Reports

The VA Office of Inspector General (OIG) conducted an inspection to evaluate a complaint regarding staffing, length of stay, and medical assessments on inpatient mental health units at the facility. Senator Elizabeth Warren referred similar concerns to the OIG regarding the inpatient mental health units. An allegation of inappropriate prescribing practices and identified concerns regarding nurse staffing methodology, recovery-oriented programming, and inpatient mental health levels of care were also reviewed. The OIG substantiated that from October 1, 2017, through September 30, 2019, inpatient psychiatry staffing was below expected staffing levels but was unable to determine if medical provider staffing was inadequate because the Veterans Health Administration (VHA) does not provide guidelines for medical staffing. The OIG did not substantiate patients had increased lengths of stay due to insufficient psychiatry staffing. From October 1, 2017, through September 30, 2019, staff did not complete the VHA-required number of utilization management reviews. The OIG did not substantiate patients remained on the acute inpatient mental health unit after psychiatric stabilization to treat medical issues that were overlooked during the admission process. The OIG did not substantiate that inpatient psychiatrists inappropriately prescribed antidepressant medications and vitamin B12 injections. From 2017 through 2019, facility leaders failed to complete VHA-required nurse staffing methodology. In January 2020, facility leaders approved the nurse staffing methodology. Inpatient mental health unit managers did not ensure the required recovery-oriented programming on Sundays, and programming did not consistently occur when scheduled. Facility leaders failed to convert sustained treatment and rehabilitation and specialized inpatient posttraumatic stress disorder beds to acute or residential beds, which resulted in staff’s failure to complete required utilization reviews. The OIG made seven recommendations related to inpatient mental health staffing, utilization management reviews, medical assessments, nurse staffing methodology, recovery-oriented programming, and inpatient mental health levels of care.

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

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the leadership performance and oversight by the Veterans Integrated Service Network (VISN) 15: VA Heartland Network, covering leadership and organizational risks and key processes associated with promoting quality care. For this inspection, the areas of focus were Quality, Safety, and Value; Medical Staff Credentialing; Environment of Care; Medication Management: Long-Term Opioid Therapy for Pain; Women’s Health: Comprehensive Care; and High-Risk Processes: Reusable Medical Equipment. The OIG conducted this unannounced visit during concurrent inspections of VISN 15 facilities. The VISN’s executive leadership team appeared stable with the Network Director, Deputy Network Director, Chief Medical Officer, and Human Resources Officer serving together for the past four years. The Quality Management Officer joined the team in June 2019. Selected survey scores related to employee satisfaction and patient experience were similar to or higher than VHA averages. The OIG’s review of access metrics and clinical vacancies did not identify any substantial organizational risks. The executive team seemed to support efforts to improve and maintain positive outcomes (such as conducting site visits to improve performance and quality care for high-risk veterans and providing training for mental health and community living center staff). The team was also knowledgeable about Strategic Analytics for Improvement and Learning metrics but should continue to take actions to sustain and improve performance. The OIG issued 10 recommendations for improvement in four areas: (1) Quality, Safety, and Value • Utilization management annual summary review (2) Medication Management • Pain Management Strategy implementation and progress report • Pain committee establishment (3) Women’s Health • Interdisciplinary strategic planning activities • Quarterly program updates • Annual site visits • Educational resource development • Access and satisfaction data analysis • Maternity care outcome data tracking (4) High-Risk Processes • Facility corrective action plans

Our report contains 13 recommendations directed to the post and headquarters. We recommend that the post improve controls related to Volunteer bank account closure, billing and collection, and imprest funds. Additionally, we recommend that headquarters strengthen internal controls related to the administration of financial-system user roles and issue medical guidelines to comply with host country laws.

This audit report is one of a series of OIG reports that addresses the identification, reporting, and investigation of incidents of potential abuse and neglect of our Nation's most vulnerable populations, including Medicaid beneficiaries in nursing facilities.Nursing facility residents are at increased risk of abuse and neglect when healthcare professionals and caregivers fail to report abuse, or when incidents of potential abuse or neglect are not acted upon in a timely manner.

On the Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (Form CMS-64) for the quarter ended September 30, 2014, Indiana claimed increasing adjustments on Line 10A, Adjustments Decreasing Claims For Prior Quarters: Federal Audit (Line 10A). We audited Indiana's methodology in claiming the increasing adjustment.