Federal Reports

We audited the general controls over the Integrated Pool Management System (IPMS) as part of the internal control assessments required for the fiscal year 2018 financial statements audit under the Chief Financial Officer’s Act of 1990. Our objective was to evaluate and assess internal controls over the safeguarding of data, security, and continued operations in the event of unexpected interruptions. Specifically, we examined the general controls over IPMS.The OIG has determined that the contents of this audit report would not be appropriate for public disclosure and has therefore limited its distribution to those officials listed on the report distribution list.

The U.S. Department of Housing and Urban Development (HUD), Office of Inspector General (OIG), assisted the U.S. Department of Justice (DOJ) and the U.S. Attorney’s Office for the Eastern and Western Districts of Washington in the civil investigation of Universal American Mortgage Company, LLC.  Our investigation was ongoing when a qui tam action was filed in the U.S. District Court for the Western District of Washington.  Universal American has its principal place of business in Miami, FL.On October 16, 2018, Universal American entered into a settlement agreement with the Federal Government.  It agreed to pay $13.2 million to avoid the delay, uncertainty, inconvenience, and expense of lengthy litigation.  The Federal Government alleged that Universal American violated HUD requirements in its origination, underwriting, and quality control of certain mortgages between January 2006 and December 2011.  The settlement was neither an admission of liability or wrongdoing by Universal American nor a concession by the United States that its claims were not well founded.Of the $13.2 million settlement, HUD FHA received $6.07 million.  The remaining portion was paid to the relator and other Federal entities.

EAC OIG, through the independent public accounting firm of Brown & Company, CPAs, audited EAC's financial statements for fiscal year 2018. The purpose of this letter is to convey a control weakness that did not rise to the level of a significant deficiency or material weakness.

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered at the San Francisco VA Health Care System. The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality, Safety, and Value (QSV); Credentialing and Privileging; Environment of Care; Medication Management: Controlled Substances Inspection Program; Mental Health: Posttraumatic Stress Disorder Care; Long-term Care: Geriatric Evaluations; Women’s Health: Mammography Results and Follow-up; and High-risk Processes: Central Line-associated Bloodstream Infections. Apart from the Director, the executive leaders were relatively new to their positions. The OIG noted the Facility leaders’ efforts to address nursing challenges, engage employees, and continue efforts to improve employee satisfaction. Patients were generally satisfied with the care provided. Organizational leadership appeared to support patient safety and quality care. However, organizational risk factors, such as potential underreporting of adverse events and lack of an integrated and functional senior level QSV framework, may contribute to future issues of noncompliance and/or lapses in patient safety. The leaders should continue to take actions to improve care and performance of selected Quality of Care and Efficiency metrics likely contributing to the current “3-Star” rating. The OIG noted findings in five of the clinical operations reviewed and issued 12 recommendations that are attributable to the Director, Chief of Staff, and Associate Director. The identified areas with deficiencies are: (1) QSV • Physician Utilization Management Advisors’ documentation of decisions • Interdisciplinary review of utilization management data (2) Credentialing and Privileging • Focused Professional Practice Evaluation process (3) Environment of Care • Environment cleanliness • Protection of patient health information • Documentation of response time during panic alarm testing • Annual review of comprehensive emergency management plan (4) Medication Management: Controlled Substances Inspection Program • Annual physical security survey • Order verification • Monthly inspections (5) Long-term Care: Geriatric Evaluations • Program evaluation