Federal Reports

The OIG investigated allegations that a tribe had improperly removed funds from the bank account of a tribally controlled school funded by the Bureau of Indian Education (BIE). We investigated whether the tribe exceeded its authority in removing the funds and whether any of the funds had been stolen.We found that the tribe did not exceed its authority by removing the funds and that no funds had been stolen. We found that the tribe removed the funds as part of an effort to spend down a $3 million surplus that had accumulated in the school’s account over several years.

Professional Clinical Laboratory, Inc. (ProLab) generally did not comply with Medicare requirements for billing travel allowances. Specifically, of the 100 travel allowance claim lines in our stratified random sample, 35 claim lines complied with Medicare requirements and 65 claim lines did not (some lines had multiple deficiencies). ProLab did not (1) support prorated miles with documentation when multiple patients were served on a single trip, (2) resubmit claims when there was a retroactive change in the clinical laboratory fee schedule, and (3) have documentation to support specimen collections.

Ohio made capitation payments totaling $90.5 million on behalf of deceased beneficiaries. We confirmed that all beneficiaries associated with the 100 capitation payments in our stratified random sample were deceased. Ohio properly recovered 37 of these capitation payments. However, Ohio did not recover the remaining 63 capitation payments totaling $74,495 ($51,431 Federal share). On the basis of our sample results, we estimated that Ohio did not recover unallowable payments to Medicaid Managed Care Organizations totaling at least $51.3 million ($38 million Federal share) during our audit period.

What We Looked AtThe Federal Information Security Modernization Act of 2014 (FISMA) requires agencies to implement information security programs. FISMA also requires agencies to have annual independent evaluations performed to determine the effectiveness of their programs and report the results of these reviews to the Office of Management and Budget. To meet this requirement, the Surface Transportation Board (STB) requested that we perform its fiscal year 2018 FISMA review. We contracted with Williams Adley & Company DC LLP (Williams Adley), an independent public accounting firm, to conduct this audit subject to our oversight. The audit objective was to determine the effectiveness of STB's information security program and practices in five function areas--Identify, Protect, Detect, Respond, and Recover.What We FoundWe performed a quality control review (QCR) of Williams Adley's report and related documentation. Our QCR disclosed no instances in which Williams Adley did not comply, in all material respects, with generally accepted Government auditing standards.RecommendationsSTB concurs with Williams Adley's seven recommendations.

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered at the VA Boston Healthcare System (Facility). The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality, Safety, and Value; Credentialing and Privileging; Environment of Care; Medication Management: Controlled Substances Inspection Program; Mental Health Care: 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. The OIG noted that Facility leaders have been in their respective positions for at least four years. Facility leaders were actively engaged with employees and patients and were continuously striving to maintain employee and patient satisfaction scores. Facility leaders appeared to support efforts related to patient safety, quality care, and other positive outcomes. However, the presence of organizational risk factors, as evidenced by Patient Safety Indicator data, may contribute to future issues of noncompliance and/or lapses in patient safety unless corrective processes are implemented and monitored. Although the leaders were knowledgeable about selected Strategic Analytics for Improvement and Learning (SAIL) metrics, the leaders should continue to take actions to sustain performance and to improve care and performance of poorly performing Quality of Care and Efficiency metrics that are likely contributing to the current “4-Star” rating. The OIG noted findings in four of the clinical operations reviewed and issued seven recommendations that are attributable to the Director, Chief of Staff, and Deputy Director. The identified areas with deficiencies are: (1) Quality, Safety, and Value • Evaluation of peer review findings (2) Credentialing and Privileging • Focused and Ongoing Professional Practice Evaluation processes (3) Environment of Care • Separate storage for clean and dirty equipment • Solid bottom shelving in equipment storage areas (4) Medication Management: Controlled Substances Inspection Program • Annual physical security actions