Federal Reports

The VA Office of Inspector General (OIG) conducted a healthcare inspection in response to a complainant’s allegations regarding an anesthesiologist who provided outpatient sedation services at the James E. Van Zandt VA Medical Center (Facility), Altoona, Pennsylvania. The OIG did not substantiate an allegation that the anesthesiologist failed to follow Veterans Health Administration (VHA) and Facility policies for controlled medication waste because the anesthesiologist documented that the entire amount was used. The OIG did not substantiate an allegation that the anesthesiologist failed to individualize patient medication dosing. The OIG substantiated allegations that the anesthesiologist used more anesthetic/sedation medication for outpatient procedures than Food and Drug Administration approved manufacturer’s instructions recommended, and Facility leaders did not provide oversight of the anesthesiologist according to VHA and Facility privileging and ongoing monitoring policies. The OIG determined that the Facility needs to reevaluate if the provider should be reported to the National Practitioner Data Bank or State Licensing Board for administering medications that were inconsistent with Food and Drug Administration approved manufacturer’s dosage instructions. Additionally, OIG staff determined that the anesthesiologist did not follow Facility policy for pre-procedure documentation for 14 of 20 identified patients and for transfer of a patient who required general anesthesia to a designated VA or non-VA Facility. In reviewing the Facility’s documented patient complaints, OIG staff did not find complaints regarding the anesthesiologist; however, the Facility’s Patient Advocate did not document and track complaints on the Patient Advocate Tracking System as required by VHA. The OIG made four recommendations related to anesthesia needs and services, provider oversight, National Practitioner Data Bank and State Licensing Board reporting, and Patient Advocate Tracking Systems database requirements.

We recently completed an audit of TVA’s use of fixed-wing aircraft (FWA). Subsequent to issuance of our report (on March 29, 2018), we received a concern that TVA-owned FWA flew to Oxford, Mississippi, home of TVA’s Board Chair, at least 76 times between January 2013 and February 2018. The concern stated “These trips to Oxford may represent additional occurrences of fraud and/or abuse, which deserve investigation by OIG. At the least, the Oxford trips are likely an inefficient use of TVA resources, which resulted in a significant number of flight legs where the aircraft [was] empty of passengers.” We performed a limited scope review of flights to and from Oxford, Mississippi, for the period January 9, 2013, through February 9, 2018, and determined none of the flights were for non-TVA business purposes. We did not look at the cost effectiveness of these flights because our previous audit determined one of the weaknesses of TVA’s FWA program was that cost comparison analyses prior to use of FWA were not performed.

What We Looked AtPart of the Federal Aviation Administration's (FAA) efforts to modernize and increase the efficiency of the Nation's aging air traffic system, Data Communications (DataComm) will play an important role in air traffic controller to flight crew communication. Thus, it is critical that FAA incorporate sufficient controls to protect against potential security threats to that communication, including an effective contingency plan to ensure a quick recovery from losses of DataComm availability. Accordingly, we initiated this audit to determine whether (1) FAA is identifying and properly mitigating security risks and (2) FAA's contingency plan is sufficient to limit the effects of DataComm availability losses. We focused on two DataComm systems during our review--the Data Communications Network Service (DCNS) and Tower Data Link Services (TDLS).What We FoundFAA is identifying--but is not mitigating--security risks in a timely manner. Specifically, two high-impact plans of action and milestones (POA&M) were scheduled to be completed in October 2017. However, as of May 10, 2018, FAA had not mitigated the two security control vulnerabilities. An Agency official stated that FAA is working with a vendor to complete the first POA&M by December 31, 2018, and the second POA&M by March 31, 2019. FAA's contingency plans for DCNS and TDLS are sufficient to limit the effects of DataComm unavailability.This report is marked For Official Use Only to protect sensitive information exempt from public disclosure under the Freedom of Information Act, 5 U.S.C. § 552. Accordingly, a redacted version of the report is posted on our website.Our RecommendationFAA concurred with our one recommendation to improve DataComm security controls.

The CSB's purchase card program, through which the agency spent $321,241 in FY 2017, is at low risk for unauthorized purchases.

Seek link below for the full report, report summary, multimedia or any agency follow-up.

The OIG audited the costs claimed by the State of Florida’s Fish and Wildlife Conservation Commission under grants awarded by the U.S. Fish and Wildlife Service (FWS) through the Wildlife and Sport Fish Restoration Program. The audit included claims totaling approximately $121 million on 100 grants that were open during the State fiscal years that ended June 30, 2015, and June 30, 2016. The audit also covered the Commission’s compliance with applicable laws, regulations, and FWS guidelines, including those related to the collection and use of hunting and fishing license revenues and the reporting of program income.We found that the Commission complied, in general, with applicable grant accounting and regulatory requirements. We determined, however, that the Commission (1) submitted its Federal Financial Reports late on multiple occasions, and (2) appeared to receive $203,589 in excess Federal reimbursement across four grants (but the Commission provided additional documentation to show it did not exceed allowable costs).Both the FWS and the Commission agreed with the one recommendation we made, and they will work together to implement corrective actions.

The Postal Service’s goal is for 95 percent of city letter carriers to return from street operations before 5 p.m. and 100 percent by 6 p.m. Carriers returning to their units on time helps the Postal Service meet its operational goals. In FY 2017, South Florida District city carriers and CCAs delivered about 2.8 billion mail pieces and 62 million packages to over 2.5 million delivery points on 3,876 routes. City carriers and CCAs returning after 6 p.m. in the South Florida District increased by 133 percent in FY 2017. Our objective was to evaluate city carriers returning to the office after 6 p.m. in the South Florida District.