Federal Reports

The OIG conducted an inspection at the request of Congressmen Pete Aguilar and Mark Takano to review concerns related to environment of care (EOC), infection control practices including Legionella testing, provider availability, leadership responsiveness, and allegations in the dental clinic at the VA Loma Linda Healthcare System, California. The EOC was unclean and furnishings needed repair and housekeeping staff did not receive standardized training in cleaning procedures. In addition, staff were deficient in the required bloodborne pathogen training. While the OIG found no specific instance of inappropriate Legionella testing, there was no standardized process for notifying clinical staff of testing results. Water temperatures were not consistently sustained to discourage Legionella growth. The room where clean equipment and sterile supplies were stored was not consistently within parameters for temperature and humidity. Corrective actions were not documented after a positive biological spore test result. Facility healthcare associated infection rates were generally underperforming Veterans Health Administration’s national averages and leaders implemented specific corrective programs with limited impact. Veterans Integrated Service Network (VISN) and facility leaders were aware of EOC concerns and did not effectively implement actions to address the concerns. Inpatient provider availability was limited due to hospitalist staffing shortages and scheduling for nocturnists. Mental health staffing levels and measures to improve access to services were improved; however, staffing issues persisted related to vacancy rates and filling vacant positions. The OIG substantiated that staff were not routinely cleaning the inpatient dental clinic but was unable to determine exposure to biohazard residue. The OIG made 12 recommendations related to EOC, infection control practices, Legionella, training, staffing, and documentation, and two VISN recommendations to implement actions from previous reviews and development of a comprehensive EOC policy.

Our objective was to determine whether controls are in place to effectively manage the U.S. Postal Inspection Service’s national security clearance processes and safeguard personally identifiable information (PII). The Postal Inspection Service processed 1,253 national security clearances between fiscal years (FY) 2016 and 2018. The Postal Inspection Service primarily grants Top Secret national security clearances; it only granted four Secret clearances during that time.

The Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) established the trust fund known as Superfund. The CERCLA requires the Inspector General of a Federal organization with Superfund responsibilities to audit all uses of the fund in the prior fiscal year (FY).

For a covered outpatient drug to be eligible for Federal reimbursement under the Medicaid program's drug rebate requirements, manufacturers must pay rebates to the States for the drugs. However, prior OIG reviews found that States did not always invoice and collect all rebates due for drugs administered by physicians.