Federal Reports

The VA Office of Inspector General (OIG) conducted its fourth determination of Veterans Health Administration (VHA) occupations with the largest staffing shortages as required by Section 301 of the Veterans Access, Choice, and Accountability Act of 2014 (VACAA). We determined that the largest critical need occupations were Medical Officer, Nurse, Psychologist, Physician Assistant, and Medical Technologist.Our analysis of the staffing gains and losses for this year’s report shows that for critical need occupations, a significant percentage of the total gains continue to be offset by staff losses. At the time of the writing of this report, VHA still does not have operational staffing models that comprehensively cover critical need occupations. In the absence of facility-specific staffing targets or an operational staffing model, determining whether facilities are making meaningful progress in filling critical staffing shortages is challenging.VHA chartered a work group to consider ways to reduce regrettable losses. The work group’s report focused on the need for additional studies to determine causative and other factors related to regrettable losses. The work group reported issuing a follow-up report in September 2017. In an effort to better understand staffing processes and identify staffing barriers, we conducted a survey of 141 VHA facilities in May 2017. We received a request from Senator Thom Tillis to evaluate staffing requirements and demand for select non-physician professionals. We included questions in the survey related to those professionals (optometrists, pharmacists, and medical technicians). We made four recommendations to the Acting Under Secretary for Health.

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Hawaii did not fully comply with Federal Medicaid requirements for billing manufacturers for rebates for drugs dispensed to enrollees of Medicaid managed-care organizations. Hawaii properly billed manufacturers for some rebates for pharmacy and physician-administered drugs. However, it did not bill for and collect from manufacturers rebates of $18.8 million ($9.7 million Federal share). For drugs that were eligible for rebates, Hawaii did not bill for rebates of $8 million (Federal share) for pharmacy drugs and $1.6 million (Federal share) for single-source and top-20 multiple-source physician-administered drugs. For drugs that may have been eligible for rebates, Hawaii did not bill for rebates of $57,783 (Federal share) for non-top-20 multiple-source physician-administered drugs with National Drug Codes. In addition, Hawaii did not bill for rebates for 122,436 claim lines for other physician-administered drugs. Hawaii did not provide us sufficient drug utilization data to determine whether these drugs were eligible for rebates and the amount of any rebates that may have been due.