Federal Reports

This audit assessed the Veterans Health Administration’s (VHA) oversight of the issuance of prosthetic supplies and devices to veterans. VA’s Prosthetic and Sensory Aids Service (PSAS) is the world’s largest provider of prosthetic devices and sensory aids. Prosthetics include not only artificial limbs, but any device that supports or replaces a body part or function such as wheelchairs and pacemakers. Sensory aids include hearing aids, optical prescriptions, low vision and mobility aids, or speech and communication aids. The cost of PSAS services increased from over $2.9 billion in fiscal year (FY) 2016 to nearly $3.5 billion in FY 2019.The VA Office of Inspector General (OIG) found weaknesses in VHA oversight contributed to PSAS staff cloning (copying) consults improperly that also affected its ability to track fulfillment times. Consequently, VHA improperly issued an estimated $15.8 million in prosthetic supplies in 2017. However, 94 percent of transactions related to deceased veterans were proper. The remaining 6 percent were improper, but the OIG did not identify evidence of fraud with respect to these errors. VHA also maintained adequate oversight of duplicate supply issuance.The OIG made four recommendations with which VHA concurred to improve oversight of the clone consult function. Specifically, the OIG called on VHA to ensure PSAS business practice guidelines include requirements for conducting and documenting reviews of cloned and pending consults; staff develop a process to verify that consults include accessory and consumable supplies for prosthetic items before issuance; establishes field consistency requirements for program reviews and evaluations, and complies with existing policy for reviewing program assessments and evaluations, and communicate the results to the regional prosthetic representatives.

The VA Office of Inspector General (OIG) conducted an inspection at the request of Representative Carol Miller in response to allegations related to timeliness and quality of care in the Emergency Department and scheduling concerns in the Oncology Clinic of a patient at the Beckley VA Medical Center (facility) in West Virginia.The OIG did not substantiate that the patient received untimely or poor-quality care in the facility’s Emergency Department. On six occasions over four months in 2019, the patient presented to the Emergency Department, was assessed, treated for the presenting complaints, and received coordinated care between the primary care provider and other providers. On two occasions, there was no documented evidence that the primary care provider communicated abnormal and critical laboratory test results with the patient. While it appears that the failure to document communication of test results did not negatively affect this patient’s care, the lack of timely follow-up of abnormal test results could contribute to poor patient outcomes.The OIG found deficits in an oncologist’s use of scheduling orders and adherence to the Primary Care and Oncology Service Agreement wait times. Although the oncologist agreed to see the patient earlier than a scheduled appointment, it was not until a second oncology e-consult was entered that an earlier appointment was scheduled. The OIG was unable to determine whether compliance with the return-to-clinic policy would have altered the patient’s course.The OIG found that facility leaders performed comprehensive reviews of the patient’s care. The OIG made two recommendations to the Facility Director related to primary care providers’ communication and documentation of laboratory results and the oncologist’s compliance with scheduling and ordering policies.

The OIG investigated an allegation of a financial conflict of interest involving a U.S. Geological Survey (USGS) employee and a family member. The complaint alleged that the USGS employee assigned to a USGS unit at a State university submitted and managed multiple research work orders (RWOs) from the USGS from which the family member was paid as a co-principal. (RWOs are funding agreements between USGS and a cooperating university.)We substantiated that the USGS employee’s actions on the RWOs and the requisition regarding the family member constituted a financial conflict of interest. The employee submitted proposals for USGS RWOs at the State university where he was assigned, listing the family member as an employee in various roles under the agreements, and did so, in part, to ensure the family member’s salary of over $187,000. The family member also assisted the employee with the proposals, including developing budgets for payments.The U.S. Attorney’s office filed a civil false claims suit against the employee in lieu of criminal prosecution. The employee agreed to a settlement, which required the employee to pay $50,000. The employee’s family member is now employed at the State university with a salary paid by Federal and State grants.

In accordance with our Annual Performance Plan Fiscal Year 2020, dated October 2019, the Office of Inspector General (OIG) conducted a review of USCP security for Member district offices. Our objectives of our review were to determine (1) the types of support USCP provided for Member district offices, and (2) if any areas existed for which USCP could provide additional support to Member district offices. Our scope included Fiscal Year (FY) 2019 and FY 2020.

Every Postal Service-owned vehicle is assigned a Voyager credit card that is used to pay for its commercially purchased fuel, oil, and routine maintenance. U.S. Bank is responsible for operating the program, and Voyager provides a weekly electronic transaction detail file of all Voyager card transactions to the Postal Service’s Fuel Asset Management System (FAMS) eFleet application. Site managers are responsible for monitoring Voyager card transactions in the FAMS eFleet application. FAMS provides a monthly Reconciliation Exception Report, capturing only transactions that are categorized as high-risk, which may be the result of fraudulent activity. Each month, the Postal Service site manager is responsible for ensuring that their driver receipts are reconciled in FAMS. The review is critical since the Postal Service automatically pays U.S. Bank weekly for all Voyager card charges.