Federal Reports

Under the Wildlife and Sport Fish Restoration Program (WSFR), the U.S. Fish and Wildlife Service (FWS) provides grant funds to eligible States to conserve, restore, and manage wildlife and sport fish resources. States may provide WSFR funds in the form of a subaward to other non-Federal entities, such as universities, to accomplish grant objectives.The National Bobwhite Conservation Initiative (NBCI) at the University of Tennessee provides data and tools to various States and external partners (such as nongovernmental organizations) to restore wild populations of bobwhite quail. State fish and wildlife agencies fund the NBCI through WSFR subawards and State hunting and fishing license revenues. The NBCI also receives subawards from external partners and direct grants from other non-FWS Federal agencies.This management advisory (1) summarizes our findings about NBCI cost allocation during audit periods prior to the NBCI’s 2017 implementation of a recharge center accounting methodology, (2) presents our determination why the currently used recharge center is not compliant with Federal regulations and WSFR guidelines, and (3) presents a potential opportunity for the NBCI to continue its work in a way that complies with Federal regulations.We make three recommendations to the FWS that address the NBCI’s compliance with Federal regulations and an additional recommendation that the FWS identify any other programs that have similar issues.

CARES Act Section 3610 allows Federal agencies to reimburse their contractors and subcontractors for any paid leave, including sick leave, that the contractors provide to keep their employees or subcontractors in what the section refers to as a “ready state.” Because these reimbursements present a number of risks and the U.S. Department of the Interior (DOI) is already receiving Section 3610 claims from contractors, the DOI urgently needs to put policies in place to ensure consistent oversight of reimbursed leave costs.In this management advisory memorandum, we offer three recommendations that, if implemented, will help the DOI prevent fraud, waste, and abuse related to costs reimbursed under Section 3610.

Our report contains 13 recommendations directed to the post and headquarters. We recommend that the post improve controls related to Volunteer health information, billing and collection, and imprest fund. Additionally, we recommend that headquarters revise policies and procedures related to the distribution of medical supplies to Volunteers, as well as administration of financial-system user roles.

The VA Office of Inspector General (OIG) initiated an inspection in response to anesthesia provider practice concerns, including unsafe practices such as technique and choice of medications, alleged to have affected patient care at the W.G. (Bill) Hefner VA Medical Center in Salisbury, North Carolina. The OIG did not substantiate unsafe practices within the context of nine patient electronic health records reviewed. The OIG did not identify issues related to the quality of anesthesia care. However, initial hiring process deficiencies were noted related to the provider’s reporting, and the facility’s verification, of previous employment. The provider did not document a prior discharge from a position with a locum tenens contracting company, and facility credentialing and privileging staff did not complete timely verifications. The OIG also found gaps in the provider’s personnel file—proficiency reports for fiscal years 2013 and 2014 were missing, and when asked, facility staff were unable to locate them. The OIG noted that current Veterans Health Administration (VHA) policy does not specifically require physician applicants to list locum tenens contracting companies as part of their employment history, which could result in omissions and place facilities at risk for selecting unsuitable providers. The OIG determined that facility staff did not consistently follow VHA policy to report patient safety events and quality of care concerns, which affected facility leaders’ ability to respond and take action. The OIG made five recommendations including one to the Under Secretary for Health to review VHA’s credentialing policy related to applicants listing prior positions with contracting companies. The other four recommendations to the Facility Director related to ensuring timely applicant credentialing and privileging, completing and maintaining annual proficiency reports, providing performance and competency information to the Professional Standards Board for consideration during probationary and reprivileging reviews, and training facility staff on patient safety reporting.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to evaluate an allegation that a clinical pharmacy specialist (CPS) failed to act on a patient’s abnormal test results in fall 2018, which led to the patient going undiagnosed and untreated for pancreatic cancer for three months. The OIG determined that three months prior to the event, during an annual physical examination, a facility primary care provider failed to acknowledge or assess the patient’s unintentional weight loss. The OIG substantiated that the CPS failed to act on a patient’s abnormal test results and communicate those results to the patient. However, the OIG was unable to determine if immediate action by the CPS would have led to the patient receiving a prompt diagnosis and treatment for pancreatic cancer. The OIG found that the CPS also did not document a change in the patient’s plan of care. The current electronic health record used within the Veterans Health Administration (VHA) lacks a process to ensure that test results are communicated and acted upon by ordering providers. The OIG determined that facility policies and practices supported CPSs collaborating with primary care providers when a patient’s condition changed. Although the OIG found no evidence to indicate an overall lack of collaboration between providers and CPSs, in this case, the OIG determined that an opportunity for collaboration was missed. The OIG found that facility leaders provided oversight of patient care delivered by CPSs. The OIG made one recommendation to the Veterans Integrated Service Network Director to conduct a comprehensive review of the patient’s episode of care and take action as indicated. The OIG made one recommendation to the facility Director to ensure staff are aware of and follow the VHA directive regarding communication of test results.