Federal Reports

Our objective was to assess the company’s efforts to support New Jersey Transit (NJ Transit) and oversee company interests as construction advances.We found that the project is both on budget and on schedule, as of January 2024, but we also found that the company has opportunities to improve its support to NJ Transit, the lead sponsor of the project, and better oversee its own interests. Specifically, it did not anticipate the demand for track outages and company labor, it had differing expectations with NJ Transit related to information sharing, and it did not initially staff its project team to effectively manage its work on the project.We recommend improvements to the company’s process for identifying outage, labor, and information needs at the outset of future projects. Further, for the Portal North Bridge project, we recommend that the company assess and address where information-sharing expectations may continue to vary with NJ Transit.

The Additional Supplemental Appropriations for Disaster Relief Act, 2019, provided DOI with approximately $327 million to support disaster response.

To learn how communities across the nation responded to the pandemic, we initiated a multi-part review of six communities—two cities, two rural counties, and two Tribal reservations. This report is the first community-specific report and focuses on our work in Springfield, Massachusetts, where we previously identified that recipients, including city government, small businesses, and individuals, received almost $1.88 billion from 52 pandemic relief programs and subprograms. This report provides a closer look at nine pandemic programs and subprograms provided to Springfield by eight federal departments.

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report describes the results of a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the VA Maryland Health Care System, which includes the Baltimore VA Medical Center (central Baltimore), Loch Raven VA Medical Center (northern Baltimore), Perry Point VA Medical Center (Perry Point), and multiple outpatient clinics in Maryland. This evaluation focused on five key operational areas:• Leadership and organizational risks• Quality, safety, and value• Medical staff privileging• Environment of care• Mental health (suicide prevention initiatives)The OIG issued five recommendations for improvement in three areas:1. Medical staff privileging• Ongoing Professional Practice Evaluation recommendations and results2. Environment of care• Biohazard sign posting• Safe and clean patient care areas• Panic alarm testing in the inpatient mental health unit3. Mental health• Comprehensive Suicide Risk Evaluation completion

The OIG received a hotline complaint about delays by staff at the Martinsburg VA Medical Center in processing and scheduling veterans’ community care consults. These consults are referrals to non-VA providers for clinical services. The OIG substantiated that as of February 28, 2023, there were over 5,000 active consults (meaning staff were working to process them), that staff took more than 100 days to make the first contact attempt with the veteran, and that staff took longer than 45 days on average to schedule veterans for care in the community (well in excess of the seven-day requirement). While evaluating the merits of the specific complaints, the OIG learned that, in an effort to make staff aware of the repercussions of untimely scheduling, the chief of community care had sent her whole team a list of veterans who had passed away with unscheduled consults. The list contained personally identifiable information. The OIG determined that community care scheduling delays occurred because of (1) ineffective processes used to manage community care consults, (2) shortages of specialty care providers, such as in otolaryngology, gastroenterology, radiology, orthopedics, and cardiology, and (3) a lack of controls to ensure manager accountability for consult timeliness. The OIG recommended ensuring that personal information of veterans is only shared on a need-to-know basis, evaluating alternative workflows to improve consult processing and scheduling, exploring ways to increase the availability of specialty care providers, and adding to the community care chief’s performance plan standards related to the metrics for community care.

Endo Health Solutions Inc. (EHSI) was ordered May 2, 2024, to pay $1.086 billion in criminal fines and an additional $450 million in criminal forfeiture—the second-largest set of criminal financial penalties ever levied against a pharmaceutical company—for violations of the federal Food, Drug and Cosmetic Act (FDCA), according to the U.S. Department of Justice.EHSI pleaded guilty April 18, 2024, to one misdemeanor count of introducing misbranded drugs into interstate commerce. In its plea, EHSI admitted that from April 2012 through May 2013, some of its sales representatives marketed Opana ER with INTAC (Opana ER) to prescribers by touting the drug’s purported abuse deterrence, tamper resistance, and/or crush resistance despite a lack of clinical data supporting those claims. In addition, approved labeling for Opana ER did not provide adequate information for healthcare providers to safely prescribe Opana ER for use as an opioid that is abuse deterrent. According to the plea agreement, EHSI was responsible for the misbranding of Opana ER by marketing the drug with a label that failed to include adequate directions for its claimed abuse deterrence, in violation of the FDCA. EHSI withdrew Opana ER from the market in 2017. The investigation, supported by our office, found that some Amtrak employees and dependents were prescribed the misbranded drug.