Federal Reports

The VA Office of Inspector General (OIG) audited the Veterans Health Administration’s (VHA’s) Office of Community Care (OCC) to determine the accuracy of bulk payments made to third party administrators (TPAs) under contracts that include care provided through the Veterans Choice Program. The OIG found about $66.1 million in duplicate payments and $35.3 million in three other payment error types, for a total of $101.4 million in estimated overpayments to the TPAs from March 4, 2016, to March 31, 2017. The Veterans Choice Program allows veterans to obtain care within their community and is administered under contracts with two TPAs, Health Net Federal Services and TriWest Healthcare Alliance Corporation. The TPAs perform a variety of administrative services, including paying claims from healthcare providers. In 2016, the OCC implemented a method to process health care claim payments to TPAs on an aggregated basis, referred to as bulk payments. This process did not have effective internal controls in place to detect improper claims. Because of ineffective internal controls, the OCC failed to identify improper claims being submitted by the TPAs. The OIG recommended that VHA continue to support processes to prevent duplicate payments and ensure that controls are in place to prevent duplicate payments to TPAs through all current and future payment methodologies for community care. The OIG further recommended that OCC and VA’s Office of General Counsel continue to work collaboratively with all relevant government authorities to determine a process for reimbursement of overpayments by TPAs. This is the second OIG report on OCC’s process for paying claims under the Veterans Choice Program. The prior audit report, Audit of the Timeliness and Accuracy of Choice Payments Processed Through the Fee Basis Claims System (Report No. 15-03036-47, December 21, 2017), addressed claims processed through the Fee Basis Claims System.

Coordination and Optimization Technologies (COTs) — a combination of algorithms, data analytics, machine learning and platform technologies — are playing a critical role in driving innovation in parcels delivery, such as on-demand deliveries by independent drivers or the in-store fulfillment of ecommerce orders. COTs also elevate customers’ expectations for faster, customized deliveries. The OIG worked with an academic institution with an urban logistics research center to identify applications that illustrate how COTs could further help USPS position for the future and become a nimbler “any-time, anywhere” parcels delivery platform.

The mixed delivery and collection vehicle fleet primarily supports Postal Service operations such as mail collection, mixed package delivery routes, and relay drop-offs for city carriers. However, the existing fleet of vehicles had aged beyond its planned life, requiring frequent repairs. To address these issues, the Postal Service made an investment to replace 6,533 vehicles and completed their deployment in December 2017. Our objective was to determine whether the Postal Service’s mixed delivery and collection vehicles acquisition achieved the performance metrics, expected costs, and savings.

As part of our annual audit plan, we audited costs billed to the Tennessee Valley Authority (TVA) by CLEAResult East Operating, LLC (CR) for providing services to assist TVA in the Valley-wide implementation of its energy efficiency programs under Contract Nos. 5586 and 6632. Our audit included approximately $45.9 million in costs paid by TVA between April 1, 2014, and March 31, 2016. Our audit objective was to determine if the costs billed to TVA were in compliance with the terms and conditions of Contract Nos. 5586 and 6632.In summary, we determined CR overbilled TVA $191,867, including (1) $158,812 in subcontractor costs, (2) $2,766 in unsupported labor costs, (3) $27,750 for ineligible sales tax costs, and (4) $2,539 in travel costs. In addition, we noted CR billed TVA approximately $1.15 million for holiday and paid time off (PTO) hours under Contract No. 5586 in which TVA did not (1) obtain any assurance CR's PTO costs were not also included in the hourly billing rates or (2) limit the amount of PTO CR could bill under the contract.(Summary Only)