Federal Reports

ICE Enforcement and Removal Operations (ERO) faces challenges in implementing the Known or Suspected Terrorist Encounter Protocol (KSTEP) screening process, which is used to identify aliens who may be known or suspected terrorists. Although ERO uses KSTEP to screen all aliens who are in ICE custody, ERO policy does not require continued screening of the approximately 2.37 million aliens when released and under ICE supervision. We sampled and tested 40 of 142 ERO case files of detained aliens identified as known or suspected terrorists during fiscal years 2013–15. All 40 files had at least one instance of noncompliance with KSTEP policy, generating greater concerns regarding the population of aliens screened and determined to have no connections to terrorism.

Wisconsin Physicians Service Insurance Corporation understated the Medicare segment allocable pension costs by $1.5 million and understated the Other segment allocable pension costs used to calculate its indirect cost rates by $7.2 million for calendar years 2008 through 2013.

Wisconsin Physicians Service Insurance Corporation did not claim $1.0 million of allowable fiscal intermediary and carrier contract Medicare pension costs on its Final Administrative Cost Proposals for fiscal years 2008 through 2013.

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered at the New Mexico VA Health Care System (facility). The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality, Safety, and Value; Medication Management: Anticoagulation Therapy; Coordination of Care: Inter-Facility Transfers; Environment of Care; High-Risk Processes: Moderate Sedation; and Long-Term Care: Community Nursing Home Oversight. OIG provided crime awareness briefings to 33 employees.The facility has generally stable executive leadership to support patient safety, quality care, and other positive outcomes. However, the presence of organization risk factors, as evidenced by sentinel events, disclosures, and Patient Safety Indicator data, may contribute to future issues of noncompliance and/or lapses in patient safety unless corrective processes are implemented and continuously monitored. Facility leaders should continue to take actions to improve performance of selected Strategic Analytics for Improvement and Learning metrics, particularly Quality of Care and Efficiency metrics.OIG noted findings in the six areas of clinical operations reviewed and issued 20 recommendations that are attributable to the Facility Director, Chief of Staff, Nurse Executive, Associate Director, and Assistant Director. The identified areas with deficiencies are:(1) Quality, Safety, and Value • Ongoing Professional Practice Evaluation data review• Utilization management documentation(2) Medication Management: Anticoagulation Therapy• Quality assurance data review• Patient education• Required laboratory tests • Employee competency assessments (3) Coordination of Care: Inter-Facility Transfers• Transfer data analysis and reporting • Patient transfer documentation • Communication with accepting facility (4) Environment of Care• Environment of care rounds frequency and attendance• General cleanliness• Outdated supplies• Physical security risk assessment • Mental health unit employee and inspection team training(5) High-Risk Processes: Moderate Sedation• Informed consent• Timeout participation and checklist(6) Long-Term Care: Community Nursing Home Oversight• Oversight committee representation • Monthly clinical visits

OIG conducted an inspection in response to allegations regarding gynecology and women’s health primary care services at the VA Gulf Coast Veterans Health Care System (system), Biloxi, MS. Specifically, the allegations were that a system gynecologist turned away patients by cancelling their consults for routine cancer screenings; did not order the correct test for a patient who was contemplating a hysterectomy; refused to perform two tubal ligations; refused to reorder medications for a patient; failed to document gynecology procedures correctly; and failed to use a colposcope to perform colposcopies. Additional allegations were that a Women’s Health Clinic physician assistant was not addressing a patient’s medical care and that system gynecologists lived too far away to be on-call for surgical patients. We did not substantiate the above allegations, except that a system gynecologist did not reorder a medication for another gynecologist’s patient. However, we determined that it was reasonable for the covering gynecologist to defer reordering to the regular gynecologist. During the inspection, we identified several issues under the responsibility of medical leadership: providers did not always follow Veterans Health Administration (VHA) cervical cancer screening guidelines; loop electrosurgical excision procedures were performed in the operating room with general anesthesia; communication and collaboration was lacking between gynecologists and providers and between providers and patients that may have affected safe and effective patient care; a care coordination agreement was outdated; and one gynecologist’s privileges were not in compliance with system required experience to perform surgical procedures. We also found that the Patient Advocacy Program, under the responsibility of system leadership, was not tracking complaints as required by VHA. We made six recommendations.