Federal Reports

The Office of Inspector General (OIG) received an anonymous complaint alleging that Secretary of Veterans Affairs David Shulkin and other senior leaders misused VA funds by taking an official July 2017 trip to Europe for more personal than official activities. Secretary Shulkin traveled with a group that included senior VA leaders, his wife, and a six-member security detail. The 11-day trip included two extensive travel days and three-and-a-half days of official events—with a cost to VA of at least $122,334. The VA delegation had a day-and-a-half of meetings with Danish veterans’ healthcare officials and experts in Copenhagen and attended the Ministerial Summit on Veterans’ Affairs in London. Secretary Shulkin stated that he also worked on VA matters when there were no official functions. The group’s schedule, however, included significant time for preplanned tourist activities by Secretary Shulkin, his wife, and others on the delegation. After a thorough investigation, OIG’s findings included (1) the Chief of Staff’s alteration of a document and misrepresentations to ethics officials caused Secretary Shulkin’s wife to be approved as an “invitational traveler,” which authorized VA to pay her travel costs (although only airfare was claimed); (2) Secretary Shulkin improperly accepted a gift of Wimbledon tickets and related hospitality; (3) a VA employee’s time was misused as a personal travel concierge to plan tourist activities exceeding that necessary for security arrangements; and (4) travelers’ documentation was inadequate to determine the trip’s full costs to VA. The OIG did not assess the value of the trip to VA or determine whether the Europe travel, as conducted, was “essential,” per VA policy. The OIG made five recommendations to ensure reimbursement to VA by the travelers of all unallowable expenses incurred; redress of any VA employee misconduct; and retraining of VA personnel on ethics and travel policy matters.

Protecting Sensitive Security Information (SSI), which can pose a risk to transportation security if released, must be balanced with ensuring transparency. Our objective was to determine whether the Transportation Security Administration (TSA) SSI Program office appropriately reviews and redacts SSI. The TSA SSI Program office has policies and procedures to identify and redact SSI. In addition, the office uses SSI Identification (ID) guides to help TSA and Department of Homeland Security personnel identify SSI. Yet, several ID guides are outdated, which could lead to improperly identifying and marking SSI. We examined 80 reviews processed by the SSI Program office and determined that the office follows policies and procedures, but the existing controls are not always effective. We identified errors in marking information for redaction. The SSI Program office resolves most challenges by stakeholders to its redactions through informal, program-level discussions, but we did not observe documentation verifying resolution of these challenges. Further, because the office does not consistently track them, the total number of challenges to redactions is unknown. TSA could improve its review and redaction process by updating the ID guides, documenting justifications for changing redactions, and tracking challenges to redactions.

Hyperbaric oxygen therapy (HBO therapy) involves giving a patient high concentrations of oxygen within a pressurized chamber in which the patient intermittently breathes in 100-percent oxygen. A prior Office of Inspector General review identified issues with Medicare payments for HBO therapy. More recently, a review by a Centers for Medicare & Medicaid Services (CMS) contractor found that claims for HBO therapy services were denied because of a lack of medical documentation. In 2015, CMS began a prior authorization demonstration program for non-emergent HBO therapy to test its effectiveness.

Payments made to providers for specimen validity tests did not comply with Medicare billing requirements. Specifically, Medicare improperly paid 4,480 clinical laboratories and physician offices a total of $66.3 million for specimen validity tests billed in combination with urine drug tests. Centers for Medicare & Medicaid Services (CMS) officials explained that medically necessary tests used to diagnose certain conditions (which include the same tests that can be used to validate urine specimens) that are performed on the same day as a urine drug test for a single beneficiary should be a rare occurrence.