Federal Reports

This report fulfills for 2020 the annual reporting mandate from the Patient Protection and Affordable Care Act (ACA). The ACA requires OIG to conduct a study of the extent to which formularies used by Medicare Part D plans include drugs commonly used by full benefit dual eligible individuals (i.e., individuals who are eligible for both Medicare and full Medicaid benefits). These individuals generally get drug coverage through Medicare Part D. Pursuant to the ACA, OIG must annually issue a report with recommendations as appropriate. This is the tenth report that OIG has produced to meet this mandate.

VA spends millions of taxpayer dollars annually on healthcare resources procured without competition from affiliated institutions. This report is a summary of the Office of Inspector General’s (OIG) 27 healthcare resource proposal reviews completed before VA awarded the contracts (preaward reviews) during fiscal year 2019 in order to help VA obtain the best pricing. OIG preaward reviews of healthcare resource proposals are internal reports for VA contracting officers. These reports are unpublished due to protected sensitive commercial pricing information. The OIG is publishing this summary to provide more information on the impact of these reviews. Preaward reviews provide VA with pricing recommendations based on the offeror’s actual expenses of providing the services. Preaward reports are used by contracting officers to negotiate fair and reasonable prices for the government and taxpayers. The OIG’s healthcare resources lower pricing recommendations collectively reflected approximately $198 million in estimated cost savings to VA. More than $26 million has been sustained by VA. The 27 proposals included 77,701 annual hours of physician services and services priced per procedure and ordered as needed.

The DOI will award most of its CARES Act funding to Indian Country through grants to the Bureau of Indian Affairs (BIA) and the Bureau of Indian Education (BIE). Of the $756 million, $522 million (69.0 percent) will be funded to Indian Country. As of June 13, 2020, $419,462,721, or 80.4 percent, had been obligated.These emergency response awards from the DOI–together with more than $8.7 billion in awards to Indian Country from other Federal departments—present a higher risk because they must be spent in a short period of time. In addition, we have identified Indian Country as a high-risk area in our recent Top Management Challenges reports because in the past, the BIA, the BIE, and tribes have faced many challenges with handling grant funds. This further increases the risk that Federal tax dollars will be misused, abused, and vulnerable to fraud. In addition, emergency situations could grow rapidly in size, scope, or complexity, thereby elevating the risk even higher.In this report we present lessons learned in our prior work that the DOI, the BIA, and the BIE should consider as they make awards, promote safety, and provide oversight under the CARES Act. In our previous reports, we found that the following areas are important for improved safety and successful oversight:• Ensuring Indian school safety and health while providing educational services• Providing oversight to help prevent mismanagement of financial awards• Minimizing the spread of the virus while maintaining safety within tribal detention centersThe BIA, the BIE, tribes, and tribal organizations will have specific challenges in responding to the COVID-19 pandemic. We know there are risks and complexities surrounding emergency funds that can be difficult to manage. As such, we plan to help provide oversight and ensure the CARES Act moneys are spent appropriately.