Federal Reports

This informational report details control activities implemented to strengthen enforcement of the USDA organic regulations and explains how the Agricultural Marketing Service intends to measure the effectiveness of the new organic regulations.

The VA Office of Inspector General (OIG) conducted a focused review of Veterans Health Administration (VHA) guidelines for lung cancer screening (LCS) and the requirements for a VA facility LCS program. VHA has 10 mandatory elements that must be in place for a facility to establish an LCS program.Lung cancer is the third most diagnosed type of cancer in the United States and is the leading cause of cancer deaths. Lung cancer generally has a poor prognosis, but diagnosis at an early stage improves patients’ survival. The US Preventive Services Task Force first recommended LCS in 2013 and updated the recommendation in 2021. Despite the impact LCS has on improving patients’ survival, LCS rates in the United States remain low.The OIG surveyed facility staff involved in LCS. Facility staff reported that VHA LCS guideline requirements presented barriers to broader adoption of LCS and did not ensure consistent implementation. The most frequently cited barriers by facilities without an LCS program were the absence of an LCS coordinator, the lack of adequate staffing, the absence of a patient registry, and the lack of a multidisciplinary board. The OIG determined just over half of surveyed VHA facilities reported having an established LCS program consistent with VHA guidelines for LCS.In addition, the OIG found that regardless of whether facilities had established a compliant LCS program, variability remained in how facilities identify patients who met LCS criteria. Additionally, methods for interpreting low-dose computed tomography (CT) scans varied among facilities. Ten sites completing low-dose CT scans for lung cancer reported not using an established system for classification of the results.The OIG made three recommendations to the Under Secretary for Health. Recommendations addressed the operational memorandum for LCS implementation and the lack of a requirement to offer eligible patients LCS.

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report describes the results of a focused evaluation of the inpatient and outpatient care provided at the Lebanon VA Medical Center and associated outpatient clinics in Pennsylvania. This evaluation focused on five key operational areas:• Leadership and organizational risks• Quality, safety, and value• Medical staff privileging• Environment of care• Mental health (focusing on emergency department and urgent care center suicide prevention initiatives)The OIG issued one recommendation in the Leadership and Organizational Risks area of review regarding conducting institutional disclosures for sentinel events.

We found that a USBR employee wrongfully obtained $28,524 in combined Unemployment Insurance and Pandemic Unemployment Assistance.

The EPA Office of Water issued a policy memorandum in September 2021 that incorrectly advised states that they do not have to review single audits of nonfederal entities that borrow money from state revolving funds.

An Amtrak senior manager based in Philadelphia, Pennsylvania, signed a civil settlement agreement with the U.S. Attorney’s Office, Middle District of Florida, on August 15, 2023, and agreed to pay $25,441 in restitution. Our investigation found that the employee submitted applications that contained false information to the Small Business Administration to qualify for a Coronavirus Aid, Relief, and Economic Security Act Economic Injury Disaster Loan Advance.

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report describes the results of a focused evaluation of the inpatient and outpatient care provided at the San Francisco VA Health Care System, which includes the San Francisco VA Medical Center and multiple outpatient clinics in California. This evaluation focused on five key operational areas:• Leadership and organizational risks• Quality, safety, and value• Medical staff privileging• Environment of care• Mental health (focusing on emergency department and urgent care center suicide prevention initiatives)The OIG issued five recommendations for improvement in four areas:1. Leadership and Organizational Risks• Institutional disclosures for sentinel events2. Quality, Safety, and Value• Improvement actions for peer reviews• Root cause analysis for patient safety events3. Medical Staff Privileging• Ongoing Professional Practice Evaluation results and privileging decisions4. Environment of Care• Expired supplies in supply rooms

The VA Office of Inspector General (OIG) conducted an inspection to assess concerns with access to mental health care at the Charles George VA Medical Center’s (facility) outpatient Mental Health clinic in Asheville, North Carolina. Complainants alleged concerns regarding delays in Behavioral Health Interdisciplinary Program (BHIP) assessment and psychotherapy consults; prescriber turnover; prescribers’ scope of practice; community care consults; and the role of the suicide prevention team.The OIG substantiated BHIP and psychotherapy consults were not completed within the Veterans Health Administration’s required time frame. Leaders attributed delays to staff vacancies and inefficient BHIP teams. Prescribers incorrectly believed that “permission” from the BHIP team was required before placing psychotherapy consults. Leaders did not clearly communicate with each other or fully address misperceptions about the psychotherapy consult process.The facility did not have processes to ascertain why staff leave so as to inform retention strategies that are necessary to maintain staffing levels.The OIG did not substantiate prescribers were providing care outside of their scope of practice or privileges, as applicable.Facility leaders discouraged, but did not prohibit, clinic providers from entering community care consults. Nearly all the prescribers, as well as additional non-prescribing clinic providers, submitted consults during the period of review.The OIG did not substantiate that the suicide prevention team failed to support prescribers with clinical duties, including patients with a high risk for suicide patient record flag; however, there was a general misunderstanding by some prescribers about the role of the suicide prevention team. Leaders failed to communicate to staff about the suicide prevention team’s role.The OIG made seven recommendations regarding mental health consult scheduling, community care referrals, BHIP implementation, staff retention, leaders’ communication, the role of the suicide prevention team, and follow-up care for patients with high risk for suicide patient record flags.