Federal Reports

The VA Office of Inspector General (OIG) conducted this audit to evaluate the merits of a 2018 hotline complaint alleging the executive director of the Cincinnati Education and Research for Veterans Foundation (CERV), a VA-affiliated nonprofit corporation, used the CERV credit card inappropriately for personal expenses. In addition, the OIG broadly examined whether CERV had adequate controls in place for ensuring proper expenditures and whether the CERV board of directors provided adequate oversight of CERV expenditures. The audit team did not substantiate the allegation that the CERV executive director used the CERV credit card inappropriately. The team noted that some CERV financial controls appeared effective, but identified other controls that were inadequate or absent. The audit team also found the invoice review procedures of the Cincinnati VAMC Research and Development (R&D) Budget Office did not comply with VA internal controls to confirm services were performed in accordance with the agreement before approving invoices for payment. The OIG recommended the Cincinnati VAMC director ensure CERV’s board of directors establishes policies that require responsible officials to verify adequate supporting documentation before approving expenditures. The OIG also recommended the Cincinnati VAMC director make certain that CERV’s board of directors, or responsible officials, approve reimbursements to the executive director. In addition, the OIG recommended the Cincinnati VAMC director establish procedures so the R&D Budget Office staff review VA-affiliated nonprofit corporation invoices and confirm services were performed or the goods were received in accordance with Intergovernmental Personnel Act agreements prior to payment. Finally, the OIG recommended the Cincinnati VAMC director establish procedures that require the R&D Budget Office supervisor to conduct periodic reviews of VA-affiliated nonprofit corporation invoices authorized for payment by staff, as required by VA policy.

Three Chicago-based employees were terminated from employment on December 20 and December 23, 2019, and two more resigned on December 18, 2019 and January 2, 2020, in lieu of termination prior to their administrative hearings. The five former employees participated in a medical fraud scheme in violation of company policies.Our investigation found that the former employees provided a chiropractor, based in Dolton, Illinois, with their medical and personally identifiable information, typically their names and dates of birth or those of their dependents, in exchange for cash kickbacks. The chiropractor used the information to fraudulently bill Amtrak’s health insurance plan for services that were not provided. In addition, all five employees lied to our agents during their interviews.

The OIG conducted this audit to determine whether facilities in Veterans Integrated Service Network (VISN) 8 were appropriately staffed and structured to manage the community care needs of veterans. VISN 8 serves more than 1.6 million patients across Florida, south Georgia, Puerto Rico, and the Caribbean. The audit team found that between during fiscal year 2018, patients experienced community care appointment delays in VISN 8 due to the facilities’ insufficient staffing and consult-processing structure at community care departments. These departments review, authorize, and schedule community care consults, or requests from a VA facility service for a patient to receive care from a non-VA provider. The team noted that the departments were not sufficiently staffed for administrative functions, such as contacting patients and coordinating appointments. The team also noted that merging the consult authorization and scheduling tasks within community care departments would allow scheduling to begin promptly. The OIG made five recommendations to the VISN 8 director to improve the timeliness of community care consults and to address staffing deficiencies. The recommendations included implementing a mechanism for VA facility services and community care departments to identify and routinely exchange wait time data. This exchange would ensure that patients understand potential wait times and would help staff routinely monitor the timeliness of each community care processing stage. The OIG also recommended that VISN 8 routinely monitor the VA Office of Community Care (OCC) staffing tool, ensure community care administrative staff are effectively cross trained to carry out applicable administrative consult processing duties, and monitor whether community care departments are processing consults in accordance with OCC’s guidance and recommendations. In addition, VISN 8 should implement specific facility plans to address the backlog of open consults and the growing number of new consults.

This Comprehensive Healthcare Inspection Program provides a focused evaluation of the quality of care delivered at the Southeast Louisiana Veterans Health Care System, covering leadership and organizational risks and key processes associated with promoting quality care. The areas of focus were Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; Medication Management: Controlled Substances Inspections; Mental Health: Military Sexual Trauma Follow-Up and Staff Training; Geriatric Care: Antidepressant Use among the Elderly; Women’s Health: Abnormal Cervical Pathology Results Notification and Follow-Up; and High-Risk Processes: Emergency Department and Urgent Care Center Operations. The leadership team appeared relatively stable, having worked together for seven months at the time of the inspection. Selected survey scores indicated that employees and patients were generally satisfied. Review of accreditation findings, sentinel events, disclosures, and patient safety indicator data did not identify any substantial organizational risk factors. The leaders were knowledgeable about selected Strategic Analytics for Improvement and Learning (SAIL) and community living center (CLC) metrics, but should continue to take actions to improve performance of measures contributing to the SAIL “3-star” quality rating. The new CLC had not been assigned a quality star rating as of December 31, 2018. The OIG issued 17 recommendations for improvement: (1) Quality, Safety, and Value • Review of utilization management data • Resuscitation episode reviews • Code responder training (2) Medical Staff Privileging • Ongoing and focused professional practice evaluation processes (3) Environment of Care • Medication safety (4) Military Sexual Trauma (MST) Follow-up and Staff Training • MST mandatory training (5) Antidepressant Use among the Elderly • Patient/caregiver education • Medication reconciliation (6) Abnormal Cervical Pathology Results Notification and Follow-up • Full-time women veterans program manager • Women Veterans Health Committee membership and reporting process • Cervical cancer screening data tracking • Patient notification of abnormal results (7) Emergency Departments and Urgent Care Center Operations • Emergency department backup call schedule

The objective of this audit was to determine whether internal controls over accountable paper and postal funds at the Pomona Main Post Office were managed effectively. Accountability examinations include retail floor stock (stamps sold on the retail floor), unit reserve stock (stamps used to replenish those sold on the retail floor), cash credits (cash retained in drawers after daily deposit), and money orders. Inventory can be transferred between segments; therefore, all segments of inventory must be counted to ensure accuracy.

Medicare pays a specimen collection fee when it is medically necessary for a clinical laboratory technician to draw a specimen to perform a clinical diagnostic laboratory test. When a technician travels to a nursing facility or homebound patient and a specimen collection fee is payable, the Social Security Act provides for payment of a travel allowance. Prior work found that travel allowances were at risk of being overpaid.