Federal Reports

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report describes the results of a focused evaluation of the care provided at the Samuel S. Stratton VA Medical Center and associated outpatient clinics in New York. 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 10 recommendations for improvement in the following topic areas:• Medical Staff Privileging1. Service-specific criteria2. Equivalent specialized training and similar privileges• Environment of care1. Inspection scheduling, completion, and documentation2. Police response times to panic alarm testing3. Installation and testing of over-the-door alarms for sleeping room doors in the mental health inpatient unit4. Safe environment in the mental health inpatient unit5. Patient care areas safe and clean• Mental health1. Comprehensive Suicide Risk Evaluation completion after positive suicide risk screen2. Suicide prevention outreach activities

Eric Graham, a former Amtrak conductor based in New York, used a stolen identity to obtain employment on July 8, 1998, and continued to use that identity for over twenty-years. Our investigation determined that Graham used the stolen identity to illegally obtain a passport, credit cards, Railroad Retirement Board benefits, Amtrak employment benefits including medical coverage, and to file federal tax returns. Graham separated from Amtrak voluntarily with retirement disability on October 14, 2021. On February 13, 2024, Graham pleaded guilty in Queens Criminal Court in Kew Gardens, New York, to a misdemeanor charge of Filing a False Instrument in the Second Degree and was sentenced to probation for twelve-months.

The mission of the U.S. Postal Inspection Service is to support and protect the U.S. Postal Service and its employees, infrastructure, and customers. Postal inspectors are law enforcement agents who are assigned accountable property, such as surveillance equipment, for investigative purposes. Surveillance equipment is an electronic or mechanical device used to capture communications, visual images, and physical locations for investigative purposes. As of fiscal year 2023, the Postal Inspection Service had about 10,000 pieces of law enforcement surveillance equipment valued at over $65 million. Effective management of law enforcement equipment ensures the Postal Inspection Service can fulfill its important mission of countering mail theft and narcotics in mail and preventing identity theft to support and protect the Postal Service and its customers.

We audited the U.S. Department of Housing and Urban Development’s (HUD) oversight of multifamily housing properties with failing Real Estate Assessment Center (REAC) scores or life-threatening exigent health and safety (EHS) deficiencies. Our objective was to determine whether HUD had effective oversight of multifamily housing properties to ensure that the properties were maintained in decent, safe, and sanitary condition.The effectiveness of HUD’s oversight of physical conditions in multifamily housing properties could be improved. Of the sampled properties that we reviewed, HUD did not (1) issue 45 percent of notices of violation or default to multifamily property owners in a timely manner for failure to maintain their properties in decent, safe, and sanitary condition; and (2) receive or maintain (a) 18 percent of the required EHS certifications to support that property owners corrected life-threatening deficiencies, (b) nearly 19 percent of owners’ surveys identifying all physical deficiencies, and (c) 13 percent of owners’ certifications that all deficiencies identified in REAC inspections and the owners’ surveys had been corrected and properties complied with HUD’s physical condition standards. HUD also did not ensure that its staff complied with its policy for granting extensions to cure periods specified on the notices of violation or default for 8 of the 11 approved extension requests. Further, HUD (1) could not support that it submitted 11 of 18 required quarterly or semiannual reports to Congress on the physical condition of assisted multifamily properties assessed through REAC and (2) did not submit 7 reports to Congress by the statutory due date.These issues occurred because HUD did not have sufficient procedures and controls in place at the regional and headquarter level to ensure compliance with requirements. Further, HUD lacked sufficient oversight of its staff to ensure that adequate documentation was received and maintained to monitor multifamily housing properties’ timely compliance with physical condition standards and to report oversight results to Congress in a timely manner. As a result of HUD’s not issuing notices in a timely manner, it delayed the start of the cure period for the owners to correct identified deficiencies, which increased the risk that residents were subjected to substandard living conditions for a longer period. Further, HUD’s staff did not always have the surveys and certifications necessary to monitor whether multifamily housing property owners complied with HUD’s requirement to maintain housing in a decent, safe, and sanitary condition. Lastly, Congress did not always receive timely information concerning the physical condition of assisted multifamily housing properties, and HUD was uncertain whether required reports and schedules were issued to Congress.We recommend that the Director of Multifamily Asset Management and Portfolio Oversight develop and implement adequate procedures and controls to ensure that (1) staff issues notices of violation and default within 15 calendar days of the inspection report release date and (2) the Office of Multifamily Asset Management and Portfolio Oversight is made aware when notices are issued late and takes action as appropriate to ensure that future notices are issued in a timely manner. Additionally, we recommend that the Director (1) include more specific language regarding owner surveys in future notices of violation and default; (2) develop and implement adequate procedures and controls to ensure that owner surveys, certifications, and other relevant records are maintained and retrievable from an easily accessible location and that staff members with the appropriate level of authority approve extensions to cure periods in notices of violation and default when necessary; and (3) assess and streamline the processes for preparing, reviewing, and approving the reports as appropriate to ensure that the reports are submitted to Congress on or before the required due date.