Federal Reports

VHA relies heavily on community providers for dialysis services for veterans, having spent about $1.2 billion on these services from October 2020 through September 2022. The Office of Integrated Veteran Care (IVC) is responsible for managing the delivery of community dialysis services through community care network (CCN) contracts and nationwide dialysis services contracts (NDSCs). CCN providers receive up to the Medicare rate plus some administrative fees, while NDSC providers received more than the Medicare rate.According to the MISSION Act, community provider reimbursement cannot exceed Medicare rates except in highly rural areas, in states with an all payer model, or when VA makes an exception. Although the MISSION Act was not in effect when the current NDSCs were awarded, VA must consider these requirements in future acquisitions. In fiscal year 2021, VHA announced its intent to transition dialysis services from NDSCs to the CCN. The OIG conducted this audit to determine if VHA effectively provides veterans access to dialysis services by evaluating whether it followed its prescribed referral process that prioritizes the use of available CCN over NDSC providers.VHA experienced several barriers to ensuring compliance with its community dialysis referral requirements and increasing use of CCN providers over NDSC providers. Specifically, IVC did not effectively oversee dialysis care in the community, clearly assign oversight responsibilities for community dialysis services, ensure medical facility dialysis coordinators followed required referral steps, or use available data to inform decisions. The team also found some inaccurate or incomplete data in the information system used by dialysis coordinators to identify available providers.The OIG recommended VHA clarify guidance, establish roles and responsibilities, improve data accuracy, and ensure future dialysis service contracts meet MISSION Act payment rate requirements.

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements.

The VA Office of Inspector General (OIG) conducted a national review to determine compliance with Veterans Health Administration (VHA) policy on the management of emergent care needs of acute sexual assault victim-survivors. Sexual assault is an invasive form of interpersonal violence that can have medical, psychological, and legal consequences, requiring a coordinated and compassionate response from medical providers and law enforcement officers when victim-survivors seek care.The OIG found deficiencies in adherence to VHA policy, including requirements to ensure the provision of sexually transmitted infection prophylaxis and pregnancy prophylaxis when clinically indicated, to offer psychological counseling, and in the documentation of signature informed consent for forensic examinations. The majority of VHA facilities utilized community sexual assault forensic examiner (SAFE) resources to provide forensic examinations, which was identified as a best practice for most VHA sites.Care related to acute sexual assault is a low frequency but crucial occurrence in VHA, presenting challenges maintaining staff knowledge and training. Additionally, facility and community resources as well as jurisdictional requirements on reporting and evidence collection for acute sexual assault vary across facilities. VHA policy establishes requirements to ensure that veterans have access to safe, high-quality care. However, supplemental facility policy or guidance is needed to ensure facility procedures align with local community resources and jurisdictional requirements to ensure frontline staff have easy access to current clinical practices when responding to acute sexual assault. The OIG determined that opportunities exist for many facilities to improve guidance addressing management of acute sexual assault patients. Improved facility guidance would help ensure implementation of VHA policy by providing frontline staff and VA police with relevant, accessible local procedures and resources when responding to patients presenting with acute sexual assault.The OIG made eight recommendations to the Under Secretary for Health related to practice deficiencies and improving guidance.

An Amtrak Coach Cleaner based in Beech Grove, Indiana, was terminated from employment on December 12, 2023, following his administrative hearing. Our investigation found that the employee violated company policies by falsely claiming employment with the U.S. Army from 2004-2015 on a resume he submitted to the company, when he was actually serving time in prison for arson.

An Amtrak electrician based in Wilmington, Delaware, violated company policies by engaging in outside employment by operating his general contracting business while on a medical leave of absence. The employee was on a medical leave of absence since February 2020 and had not returned to work as of the issuance of our investigative report. The employee resigned on December 12, 2023, prior to his scheduled administrative hearing.

The Pandemic Response Accountability Committee’s (PRAC) Semiannual Report to Congress, covering the period from April 1, 2023 through September 30, 2023.