Federal Reports

We found that the Department complied with IPERA because it met each of the six compliance requirements. We also found that the Department’s improper payment estimates and methodologies were generally accurate and complete. Lastly, we found that some information in the Department’s improper payment reporting was inaccurate and incomplete, as described in Finding 1. As a result, we could not accurately evaluate the Department’s performance in recapturing improper payments.

What We Looked AtThe Federal Highway Administration (FHWA) oversees more than $40 billion in annual Federal aid for national highway and bridge projects. Federal law requires aid recipients to competitively award contracts for such projects unless some other method is more cost-effective or an emergency exists. One such method is force account work, which involves the noncompetitive use of State or local resources to execute highway projects. Given the inherent risk of higher costs associated with noncompetitive practices, we initiated an audit to (1) determine the scope and magnitude of force account projects funded through the Federal-aid Highway Program and (2) assess FHWA's processes for overseeing compliance with Federal force account requirements.What We FoundFHWA officials have designated force account as a low-risk activity. As a result, FHWA does not track force account activity and thus cannot readily identify which federally funded projects used force account or the amount and type of activity that received Federal funding. In addition, the Agency provides minimal oversight, does not monitor whether States comply with force account regulations, and has gaps in its guidance. For example, while Federal regulations detail when staff can waive a cost-effectiveness determination for use of force account, the Agency's guidance does not. Consequently, States may be using force account to perform permanent repairs when there may be a more cost-effective approach. FHWA does have a risk-based stewardship and oversight framework that gives it discretion in determining the scope of its oversight, as long as it is based on objective data and information. However, without adequate policies and procedures, FHWA cannot ensure that States comply with force account requirements and expend Federal dollars in a cost-effective manner.Our RecommendationsWe made four recommendations to improve FHWA's oversight of States' compliance with Federal force account requirements. FHWA concurred with recommendations 1, 2 and 4, and partially concurred with recommendation 3--stating that it neither agrees nor disagrees with our $22.3 million estimate of unsupported costs but will take the necessary corrective actions. We consider recommendations 1 through 4 resolved but open pending completion of the planned actions.

The TVA Office of the Inspector General (OIG) meets its legal requirement to report to Congress on its results twice a year through its Semiannual Report to Congress. In this semiannual period, our audit, evaluation, and investigative activities identified more than $3.3 million in funds TVA could put to better use and recoveries.

This Comprehensive Healthcare Inspection Program (CHIP) provides a focused evaluation of the quality of care delivered at the Oscar G. Johnson VA Medical Center. The inspection covers leadership and organizational risks and key clinical and administrative processes associated with promoting quality care. At the time of the review, the areas of focus were Quality, Safety, and Value (QSV); Medical Staff Privileging (MSP); Environment of Care; Medication Management: Controlled Substances Inspections; Mental Health: Military Sexual Trauma (MST) Follow-Up and Staff Training; Geriatric Care: Antidepressant Use among the Elderly; Women’s Health: Abnormal Cervical Pathology Results Notification and Follow-Up; and High-Risk Processes: Urgent Care Center (UCC) Operations. The facility’s executive leadership team appeared relatively stable and seemed to be actively engaged with employees and patients. The leaders were also working to sustain employee and patient engagement and satisfaction which were above VHA averages and appeared to support efforts to continually improve and maintain positive outcomes, patient safety, and quality care. Review of the facility’s accreditation findings, sentinel events, disclosures, and Patient Safety Indicator data did not identify any substantial organizational risk factors. The leadership team was knowledgeable about selected Strategic Analytics for Improvement and Learning (SAIL) and community living center (CLC) metrics but should continue to take actions to sustain and improve performance of measures contributing to the SAIL “5-star” and CLC “3-star” quality ratings, respectively. The OIG issued nine recommendations for improvement in the following areas: (1) QSV • Peer review improvement actions • Interdisciplinary review of utilization management data (2) MSP • Focused professional practice evaluation for cause process (3) Mental Health • MST initial evaluations (4) Geriatric Care • Patient/caregiver education on medications • Medication reconciliation (5) Women’s Health • Women Veterans Health Committee core membership (6) High-Risk Processes • Urgent care center registered nurse staffing • Backup call provider schedule