Federal Reports

Our objective was to determine whether the Fiscal Year (FY) 2014 personnel and indirect costs the Michigan Disability Determination Services (MI-DDS) claimed for reimbursement from the Social Security Administration (SSA) were allowable.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to determine the validity of allegations regarding a hospitalist’s interactions with a patient and family when obtaining consent for do-not-resuscitate (DNR) status and determining discharge plans at the facility. The OIG was unable to determine whether the patient had decision-making capacity to consent to a DNR status when the hospitalist discussed life-sustaining treatment. The hospitalist followed policy when determining the patient’s decision-making capacity. The OIG did not substantiate that the facility failed to evaluate, plan, and coordinate the patient’s discharge. The discharge plan addressed the patient’s medications, nutrition needs, and aspiration precautions. The patient’s shortened hospital stay did not afford the Palliative Care Consult Team the opportunity to educate the patient and family about home-hospice services. After discharge, the family requested, and the patient received, home-hospice services and a nasogastric tube. The OIG was unable to determine whether the hospitalist demonstrated inappropriate and unprofessional behavior with the patient and family due to differing recollections of the interaction. While on-site, the OIG learned of three other patients for whom facility staff expressed concerns with the way the hospitalist presented prognoses and end-of-life treatment options to patients and families. The OIG team evaluated the three additional patient cases focusing on the hospitalist’s determination of patients’ DNR status. The hospitalist’s interactions lacked evidence of discussions of patients’ preferences and quality of life, which likely led to the patients’ and families’ requests to reverse DNR orders. The OIG determined that the facility had processes to provide oversight of physician behavior. The OIG made no recommendations.

What We Looked AtBetween 2009 and 2011, Congress cumulatively appropriated $10.2 billion for the High Speed Intercity Passenger Rail (HSIPR) program. As of April 2019, the Federal Railroad Administration (FRA), responsible for this program, has disbursed $8.5 billion of those funds, with approximately 35.5 percent dedicated to developing a corridor in California, managed by the California High Speed Rail Authority (CHSRA). The former Chairman of the House Committee on Transportation and Infrastructure, Subcommittee on Railroads, Pipelines, and Hazardous Materials requested that we review FRA’s risk mitigation and oversight of expenditures. Accordingly, our audit objectives were to assess FRA’s (1) risk analysis, assessment, and mitigation efforts—particularly regarding the availability of non-Federal matching funds, business plans, and financial reporting—and (2) procedures for determining whether Federal funds expended complied with applicable Federal laws and regulations. Due to the significant amount of HSIPR funds dedicated to California, our audit focused on FRA’s cooperative agreements with CHSRA. What We FoundWhile FRA took numerous actions to oversee the CHSRA agreement, FRA missed opportunities to better assess and mitigate Federal risks. Specifically, while FRA routinely found that CHSRA submissions of required planning documents were insufficient and provided CHSRA with technical assistance to improve future submissions, prior to May 2019, FRA did not document decisions on additional actions to address the repeated shortcomings. Additionally, FRA’s review of documents submitted by CHSRA did not verify underlying methodologies used to create them or make an independent assessment of their plausibility. FRA did not define minimum standards for the acceptable interim use of the project’s Central Valley segment to ensure that the initial construction segment would have independent operational utility, or ensure that CHSRA developed an acceptable interim use plan—although CHSRA missed the deadline to provide one. Finally, FRA’s review of project reimbursement requests relied on documentation that was not adequate to verify that expenditures met Federal requirements, and FRA’s review of expenditure documentation was inadequate in some cases. Our RecommendationsWe made four recommendations to improve FRA’s assessment and mitigation of risks, documentation of decisions, and processes for overseeing expenditures. FRA concurred with three recommendations and partially concurred with one. We consider all four recommendations resolved but open pending completion of planned actions.

The Office of the Inspector General conducted a review of Hydro Generation, Raccoon Mountain (Hydro RM) to identify operational and cultural strengths and risks that could impact Hydro RM’s organizational effectiveness. Our report identified strengths within Hydro RM related to (1) organizational alignment, (2) positive interactions within and outside of Hydro RM, (3) effective leadership, and (4) positive ethical culture. However, we also identified risks that could impact Hydro RM’s ability to meet its responsibilities in support of PO’s mission. These were comprised of risks related to (1) an employee’s behaviors that are inconsistent with TVA’s Values, (2) inadequate staffing, and (3) outage execution and management.