Federal Reports

Up to 80 percent of children enter foster care with significant mental health needs. For children with mental health needs, psychotropic medications (i.e., medication used to treat clinical psychiatric symptoms or mental disorders such as depression, bipolar disorder, schizophrenia, and anxiety disorders) may be effective treatments. However, these medications can have serious side effects and, as ACF suggests, should be used in conjunction with treatment planning mechanisms and effective medication monitoring.A 2015 OIG report found-based on review of medical records-serious quality-of-care concerns in the treatment of children with psychotropic medications.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to review a complaint alleging a delay in care, including surgery, after a non-VA imaging center reported mammogram results as normal for a patient with known breast cancer at the Atlanta VA Health Care System in Decatur, Georgia. The OIG found that the patient’s mammograms were stable for six years. The OIG confirmed that the spring 2016 mammogram results at issue were reported as “normal,” which was reasonable, and did not substantiate allegations that this delayed surgery. The patient had repeatedly declined surgery since 2005. Based on information developed during the course of the inspection, the OIG broadened the scope of the inspection to include 4,727 mammography orders and consults ordered from October 1, 2014, to June 22, 2017. The OIG identified 42 patients whose diagnostic mammograms were not completed and referred them to the facility for follow-up. The OIG also identified concerns related to a lack of a streamlined mammography process, delays in scheduling and retrieving results, physician review for clinical appropriateness, unscanned documents, and oversight of the Women Veterans Program, among others. The OIG made seven recommendations to the facility director to ensure patients who were transitioned from the mammography contract provider in October 2015 to other non-VA providers received care, that facility policy and practice are consistent, non-VA mammograms are scheduled timely and undergo consistent clinical review of the mammogram request, the availability of mammogram results improves, gender-specific care is provided by Women’s Health Primary Care Providers, and the facility provides executive oversight of its Women Veterans Program.

The Office of the Inspector General audited the controls for key Sarbanes-Oxley (SOX) spreadsheets to determine if the controls are sufficiently defined, appropriately designed, and operating effectively. The audit’s scope was information technology general controls for the SOX critical spreadsheets within TVA. We identified several issues that could provide a stronger control environment for critical spreadsheets. Specifically, we found (1) shared passwords used to modify critical spreadsheets are not appropriately managed, (2) one spreadsheet was accessible using a shared account with no known business need, (3) TVA’s SOX Control Environment group’s inventory controls over critical spreadsheets are ineffective, (4) critical spreadsheets are not documented consistently in SOX control narratives maintained by TVA’s SOX Control Environment group, (5) naming convention controls are not being enforced which limits TVA’s ability to quickly assess if critical spreadsheets are properly stored for access control and backup purposes, and (6) TVA’s SOX Control Environment group’s spreadsheet policy could be strengthened by adding controls for user training, baselining, templates, and testing. TVA management agreed with our findings and recommendations.