Federal Reports

The purpose of this review was to identify and address factors that contributed to the Hawaii Medicaid Fraud Control Unit's (MFCU's or Unit's) low case outcomes during federal fiscal years (FYs) 2016-18 and to assess Unit operations. In 2015, OIG issued a report from its 2014 onsite review of the MFCU that raised concerns about the Unit's ability to carry out its statutory functions and meet program requirements. To address the deficiencies identified during OIG's previous onsite review, the MFCU developed and implemented a corrective action plan. Despite this effort, we found that the Hawaii MFCU's case outcomes were low during FYs 2016-18, compared to other similarly sized MFCUs.

A Technician in Los Angeles was terminated from employment on May 20, 2020, and a Customer Service Supervisor and an Operations Supervisor from Los Angeles were terminated from employment on June 23, 2020, following their administrative hearings. Our investigation found that the employees violated company policy by allowing a doctor to fraudulently bill the company’s group health plan on their behalf. The employees accepted monetary gifts from the doctor, while allowing her to fraudulently bill the company’s group health plan.

The VA Office of Inspector General (OIG) identified potential Post-9/11 GI Bill monthly student housing allowance overpayments by analyzing nearly 10 years of participant data. The review focused on students who continued to receive housing payments more than 18 months after their latest tuition payment; received more than 36 months of housing payments; and had fewer than 365 days between each housing payment—all indicators of potential errors. The OIG found the Veterans Benefits Administration (VBA) substantially overpaid monthly housing allowances to 16 students, totaling about $961,000. These overpayments were a result of control deficiencies that allowed some payments to continue beyond the allowable limits prior to VBA taking corrective action. The OIG considered the number of individual overpayments to be minimal, as more than two million students were enrolled in classes using Post-9/11 GI Bill benefits during the more than nine-year review period. VBA’s Education Service has added controls, such as a system update to prevent monthly housing allowance payments from continuing after the entitlement has ended. These controls have improved VBA processes and should reduce future risk of the substantial monthly housing allowance overpayments found in this review. They appear to have been effective, as there were no similar overpayments identified since the last control was implemented in June 2017, which was a non-college-degree job aid tool to help minimize payment calculation errors. The overall financial impact of the overpayments identified in this review was not significant to VA. However, the OIG encouraged VBA to implement measures to further reduce the risk of future long-term overpayments, such as monthly certifications by students. The OIG did not make any recommendations because VBA’s existing and planned controls appeared to address the errors found in this focused review. VBA concurred with the findings and agreed to consider additional measures.

VA’s Office of Community Care (OCC) intended to use overtime to reduce a backlog of non-VA care claims. This backlog had been increasing since at least October 2016. The VA Office of Inspector General (OIG) examined how the overtime was used, the effect on claims backlog reduction, and whether claims processors and nurses abused overtime. The OIG found neither OCC nor its Payment Operations and Management (POM) directorate established a policy requiring employees to use overtime exclusively to process those claims or detailed appropriate uses for overtime. Officials did not implement controls to ensure employees used overtime primarily to reduce the claims backlog. A data review of a sample of 45 POM employees found the employees were paid an estimated $11.6 million for overtime hours for which there was no evidence of claims-related activity in the Fee Basis Claims System in fiscal years 2017 and 2018, representing almost half of the total overtime paid. Significantly, 16 of the 45 employees each received more than $10,000 in overtime for hours during which there was no claims-related activity. The audit team referred those cases to the OIG’s Office of Investigations. There must be effective controls in place to monitor use of overtime. The OIG found that during the scope of this audit, such controls did not exist or were ineffective. Supervisors also did not effectively manage productivity during overtime hours, creating a high risk for fraud and abuse. The OIG recommended the under secretary for health review overtime activities for certain POM employees to determine whether disciplinary or other corrective action is warranted, ensure supervisors have the tools to effectively monitor overtime productivity to reduce the risk of abuse, clarify nurse productivity standards and requirements, and implement controls on the appropriate use of overtime.

The Greensboro P&DC is in the Greensboro District within the Capital Metro Area. In fiscal year (FY) 2019, the Postal Service reported 2.1 million late trips nationwide due to contractor failure. From October 1, 2019, to March 31, 2020, the Greensboro P&DC had the third highest number (10,921) of originating late trips due to contractor failure for P&DCs. The average time a trip was late was 42 minutes. There were 34 contractors with originating late trips due to contractor failure at the Greensboro P&DC. Three contractors accounted for 70 percent of the failures. Our objective was to assess the management of HCR irregularities due to contractor failure at the Greensboro P&DC.

The National Credit Union Administration (NCUA) Office of Inspector General conducted this self-initiated audit to assess the NCUA’s Asset Management and Assistance Center’s (AMAC) ability to protect personally identifiable information (PII) found within the records of liquidated unions. The objectives of our audit were to determine whether: 1) AMAC management’s control activities over the liquidation process adequately considers and safeguards PII from initial identification to destruction; and 2) AMAC’s liquidation activities comply with applicable policies, procedures, laws, and regulations relating to the protection of PII.

OIG evaluated RUS’ monitoring and oversight of the Section 313A Program.