Federal Reports

The VA Office of Inspector General (OIG) conducted a healthcare inspection to evaluate allegations related to nurse staffing and inadequate supplies. The OIG did not substantiate deaths occurred due to untimely patient transfers between the Emergency Department and inpatient units because of insufficient nurse staffing. Due to lack of documented evidence, the OIG was unable to determine if there were unsafe working conditions related to high patient-nurse ratios. The OIG did not find an increase in the number of adverse events January 1, 2016, through June 30, 2017, and was not able to make a correlation between the adverse events that did occur and nurse staffing issues. The OIG substantiated that the system had inadequate supplies including linens but had taken actions to improve the deficiencies. The OIG found that 35 percent of Emergency Department patients admitted to the system from August 1, 2016, through June 30, 2017, waited for four hours or more (boarders) to be transferred to their assigned units. Quality of care concerns were identified for five of 13 boarder patients that the OIG reviewed related to their not receiving the same level of care in the Emergency Department as they would have received in the assigned units. The OIG also identified deficiencies in the reporting of closed beds, accuracy of data collected in the Emergency Department, coordination of care between the system and the Robley Rex VA Medical Center, located in Louisville, Kentucky, for a traveling patient, and a potential patient safety issue related to a faulty Emergency Department surveillance camera. The OIG made 10 recommendations related to Emergency Department patient flow, accurate data collection, boarders’ level of care; coordination of care; completion of root cause analyses, and a review of two patients who suffered injuries after falls at the system.

Previous OIG work found that Medicaid may have paid for drugs in 2008 that were not approved by the Food and Drug Administration (FDA) as safe and effective. To qualify for Federal payments under Medicaid, drugs must be FDA-approved unless they meet the criteria for an exception-for example, prescription prenatal vitamins or drugs that are prescribed during times of drug shortages.

On January 31, 2018, the VA Office of Inspector General (OIG) received allegations that a psychologist at the Temple campus of the Central Texas Veterans Health Care System double-coded group therapy sessions and received improper overtime pay. Double coding refers to inappropriately entering duplicate codes to a patient encounter when only a single code would be appropriate. This audit substantiated that the psychologist improperly coded mental health services for about 66 percent of patient encounters for a 20-week period. The psychologist double-coded services, used codes not supported by the medical documentation, and entered codes not permitted for psychologists’ use. Also, the psychologist received about $7,700 in salary for clinic time not spent providing direct patient care and more than 243 hours in unnecessary overtime pay. During the review, the team developed concerns that other psychologists were also coding patient encounters improperly. The OIG found similar errors, except for double coding. The team estimated that other psychologists entered improper codes for about 29 percent of the encounters completed during the same period. The coding errors occurred because the chief of psychology failed to make sure that staff attended training or otherwise received proper instruction. The chief also failed to provide oversight by not reviewing the health care providers’ coding for accuracy. Furthermore, the chief of Health Information Management failed to perform mandatory annual coding reviews for each provider. The OIG recommended stronger oversight and that the director of the Central Texas Veterans Health Care System ensure all psychologists receive medical coding training. The OIG also recommended improving the review of overtime hours, ensuring facility hours are used to provide direct patient care, and confirming psychologists follow VHA’s scheduling policies and use approved systems.