Federal Reports

We determined that the Department of Homeland Security has established a process that provides guidance to identify required capabilities, gaps, and opportunities, which are found in capability needs documents. The Department also has controls in place to prevent components from circumventing this process. However, the Department validates noncompliant capability needs documents. DHS does not hold components accountable for failing to follow guidance and also has not provided adequate direction on how to implement the guidance. As a result, the Department cannot be assured that capability needs are properly identified. Additionally, Department analysts are not consistent when reviewing capability documents and applying departmental guidance and the acquisition decision making process is not always documented. This occurred because the Department has neither standard operating procedures to help its analysts consistently review documents and provide feedback, nor a written policy requiring documentation to support validation decisions. Inconsistent analyst reviews affect the Department’s ability to make informed decisions about components’ assessments of capability needs. It may result in components expending additional resources to develop capability documents and may delay the Department’s acquisition of needed goods and services. Furthermore, without proper documentation, issues identified during capability document reviews may not be addressed prior to validation. The Department concurred with the recommendations and described corrective actions taken. We consider three of the four recommendations closed. However, actions taken to address the remaining recommendation do not address the intent of the recommendation. Therefore, we consider the remaining recommendation open and unresolved.

The VA Office of Inspector General (OIG) identified a primary care provider who appeared to have falsely documented patients’ blood pressure readings at the Danville Community Based Outpatient Clinic (CBOC) of the Salem VA Medical Center (facility), Virginia. The CBOC is a contracted clinic staffed and operated by Valor Healthcare, Inc. In a preliminary review, OIG inspectors identified that the provider repeatedly documented blood pressure rechecks of 139/89. The OIG immediately notified the facility’s Chief of Staff (COS) and recommended a comprehensive analysis be done to evaluate the extent of the 139/89 entries. In an expanded review, the OIG determined the provider had not only falsified repeat blood pressure readings (readings higher than 139/89 would have required additional follow-up), but also failed to provide hypertension management to patients with initially elevated blood pressure readings. An OIG physician found limited evidence of interventions, treatment plan adjustments, medication changes, or close follow-up. Further, the OIG found the COS’s initial response to be troubling. Despite being told of the concerns, it was not until the OIG team contacted the COS eight weeks later that the facility began an in-depth review of the provider’s documentation practices and management of patients with hypertension. Multiple factors allowed the provider’s falsification of blood pressure readings to continue unabated, including lack of facility processes to validate the accuracy of performance measure data impacting monitoring reports. In addition, • None of the Valor Healthcare employees with knowledge of the falsified blood pressure documentation shared their concerns with staff positioned to take corrective action, and • Neither the facility nor Valor Healthcare were meeting aspects of the contract. The OIG made five recommendations related to patient care follow-up, data integrity, policy and procedure development, leadership responsiveness, and contract-related training.