Federal Reports

Not all of the direct medical service costs that the Texas Health and Human Services Commission (State agency) claimed for Medicaid School Health and Related Services (SHARS) were reasonable, adequately supported, and otherwise allowable in accordance with applicable Federal and State requirements. Specifically, Fairbanks, LLC (the Contractor), coded random moments incorrectly. Of the 3,161 random moments coded as an Individualized Education Plan-covered direct medical service, 274 were coded incorrectly. As a result of these errors, the State agency received $18.9 million in unallowable Federal reimbursement for the Medicaid SHARS program during the period October 1, 2010, through September 30, 2011.

The Office of the Inspector General previously conducted an evaluation of Bull Run Fossil Plant (BRF) (Evaluation Report 2015-15357 issued March 30, 2016) to identify strengths and risks that could impact BRF's organizational effectiveness. Our final report identified several operational and cultural areas for improvement along with recommendations for addressing those issues. The objective of this follow-up evaluation was to assess management's actions in response to our recommendations from our initial organizational effectiveness evaluation. In summary, we determined the actions taken by BRF appear to address most areas for improvement identified during our initial organizational effectiveness evaluation, and for the most part, individuals reported seeing positive changes at BRF. Some concerns remain related to specific areas in the work management process, including planning of work and communication of work order and condition report statuses. However, resolution of these concerns relies on funding decisions that are generally outside of BRF's control.

The Department of Homeland Security made progress in implementing the JTFs since their inception in 2014. According to JTF leaders, operational effectiveness and efficiency has increased; staff morale has improved; and components have successfully worked together to promote information sharing and communication.Although the JTFs are a step forward for DHS, they face challenges, including a need for dedicated funding and outcome-based performance measures. Without dedicated funding, the JTFs rely on components that may have competing or conflicting priorities. Without performance metrics, the JTFs cannot show the value they add to homeland security operations.The Department of Homeland Security made progress in implementing the JTFs since their inception in 2014. According to JTF leaders, operational effectiveness and efficiency has increased; staff morale has improved; and components have successfully worked together to promote information sharing and communication.Although the JTFs are a step forward for DHS, they face challenges, including a need for dedicated funding and outcome-based performance measures. Without dedicated funding, the JTFs rely on components that may have competing or conflicting priorities. Without performance metrics, the JTFs cannot show the value they add to homeland security operations.We made no recommendations.

In October 2016, OIG evaluated the New Orleans VARO to see how VSC staff processed disability claims, timely and accurately processed proposed rating reductions, input claim information, and responded to special controlled correspondence. Staff did not consistently process one of the two types of disability claims we reviewed. OIG reviewed 30 veterans’ TBI claims and found staff accurately processed all 30 claims. OIG reviewed 30 SMC benefits claims and found VSC staff incorrectly processed four claims because second signature reviews were ineffective. The four claims with errors had the required secondary reviews; however, the reviewers did not identify the errors. Overall, VSC staff accurately processed 56 of the 60 disability claims OIG reviewed—the four errors resulted in 25 improper payments to four veterans totaling approximately $25,500. OIG reviewed 30 rating reductions cases and found VSC staff delayed or incorrectly processed six of the cases. Delays occurred because VSC managers prioritized other workload. Delays and inaccuracies resulted in eight improper payments, representing approximately $2,800 in overpayments. OIG reviewed 30 newly established claims and found VSC staff entered inaccurate or incomplete information into the electronic systems in 21 of 30 claims because VSC staff did not complete all required training related to establishing claims, and the quality review process for this function was ineffective. OIG reviewed 30 special controlled correspondences, finding inaccuracies in 21 cases because management was unaware that staff did not follow VBA policy when processing the correspondence. Specifically, staff did not send interim responses when required or ensure consent to release records to third parties were of record prior to releasing records. Staff also used incorrect dates to establish workload controls and did not associate the correspondence with the electronic record as required. In addition, errors occurred because training for staff on processing controlled correspondence did not exist. OIG recommended the New Orleans VARO Director assess the effectiveness of secondary reviews for SMC claims; train VSC staff responsible for establishing claims to do so using accurate and complete information; and strengthen the quality review over the course of this process. The VARO Director should ensure staff comply with VBA policy when processing special controlled correspondence and ensure they are trained in processing this workload. Additionally, OIG recommended the Continental District Director ensure the timely processing of the rating reduction workload. The VARO Director and Continental District Director concurred with our recommendations; planned corrective actions are responsive.