Federal Reports

The VA Office of Inspector General (OIG) conducted a healthcare inspection to assess anonymous allegations involving multiple quality of care and leaders’ failures at the facility. Many of the allegations were largely unfounded; however, the OIG identified concerns including clinical staff members who did not feel supported by the leadership team and who described communication styles that were not consistently viewed as professional, positive, or oriented toward problem-solving. The hiring process was inefficient and problem-prone, and nurse staffing in the critical care unit (CCU) was problematic. Communication about, and understanding of, certain facility policies was inadequate. The OIG team identified deficits in completion and documentation of CCU nurse competency assessments, and found that the facility did not respond adequately to a 2018 sentinel event. Poor nursing morale was attributed to inadequate nurse staffing levels, guidance, and accountability. Emergency department nurse staffing issues had not been adequately addressed. The OIG identified other emergency department issues related to security, availability of laboratory services, and unclear policies regarding patient transfers that potentially placed emergency department patients at risk. Communication surrounding the use of a connecting bridge between the facility and Augusta University Medical Center was a confusing and contentious problem for staff of both institutions. Despite the facility’s complex designation, various clinical services were periodically reduced or unavailable. The OIG made 27 recommendations involving communication, hiring processes, staffing in the CCU and emergency department, policy development and communication, nurse competencies, nasogastric tube procedures, provider privileges, and emergency department security, among other areas.

We audited Bank2’s origination of Section 184 Loan Guarantees for Indian Housing program loans. We selected Bank2’s Section 184 program because (1) an internal audit report and corrective action verification determined that the U.S. Department of Housing and Urban Development (HUD) lacked proper oversight of the program and lenders did not underwrite loans in accordance with HUD requirements 2) Bank2 is one of the largest Section 184 lenders, and (3) reviews of Section 184 lenders were aligned with the goals of our annual audit plan. Out audit objective was to determine whether Bank2 originated Section 184 Loan Guarantees for Indian Housing Loans in accordance with HUD’s processing guidelines.Bank2 originated all 14 loans reviewed in accordance with Section 184 Loan Guarantees for Indian Housing program processing guidelines. Specifically it ensured that borrowers met income, debt, and credit requirements; property values were supported; and the borrower and properties were eligible for the program. Because the 14 loans reviewed met the processing guidelines, there was not an increased risk to HUD’s Loan guarantee Fund.This report contains no recommendations.

The Refugee Act of 1980 created the Refugee Resettlement Program (RRP) to provide for the effective resettlement of refugees and to assist them in achieving economic self-sufficiency after arriving in the United States. The Act provides Federal grants to States for cash and medical assistance, social services, and targeted assistance to help qualified refugees. Within HHS, the Administration for Children and Families, Office of Refugee Resettlement (ORR) runs the RRP program. In 2015 and 2016, ORR obligated $286 million and $417 million, respectively, to States for the RRP.