Federal Reports

This report responds to a request from Sen. Heidi Heitkamp of North Dakota about employee issues at the Dickinson Post Office. In response to that request, our objectives were to determine whether the U.S. Postal Service complied with employee payment requirements and assess employee engagement and staffing levels at the Dickinson, ND, Post Office.

We determined that not all forms DHS and its components use to create Non-Disclosure Agreements (NDA) include the required Whistleblower Protection Enhancement Act (WPEA) statement. Further, although many of the settlement agreement templates and settlement agreements in the sample we reviewed included provisions that might restrict or prevent disclosure of information, nearly three-fourths of these documents did not contain the WPEA statement. Omitting the statement in NDAs and personnel settlement agreements could lead to confusion about what information may be disclosed to permissible recipients, which could deter reporting of fraud, waste, or abuse and impede DHS Office of Inspector General activities.

FEMA needs to continue providing technical assistance to and monitoring of California’s Public Assistance grant funding management. This helps avoid the risk of exposing millions of taxpayer dollars to fraud, waste, or mismanagement and violating the Robert T. Stafford Disaster Relief and Emergency Assistance Act. In doing so, FEMA can assist California in providing reasonable, but not absolute assurance that Public Assistance subgrant funds are spent in accordance with Federal regulations and FEMA guidelines.

The objective of this Management Advisory Report was to create an understanding of how drug use among Volunteers has affected the agency and its Volunteers since 2015, and how challenges in enforcement and data gathering have impeded agency efforts to address the problem. This report included six recommendations.

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the Tomah VA Medical Center (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: Post-Traumatic Stress Disorder Care; Long-Term Care: Geriatric Evaluations; and Womens Health: Mammography Results and Follow-Up. The OIG also provided crime awareness briefings to 74 employees. The Facility currently has stable executive leadership and active engagement with employees and patients, as evidenced by satisfaction scores. The leaders are improving patient satisfaction and had expanded selected programs and services. However, the OIG noted deficiencies with the Leadership Quality Council’s multidisciplinary team review and analysis of aggregated data. The OIG’s review of accreditation organization findings, sentinel events, Patient Safety Indicator data, and Strategic Analytics for Improvement and Learning (SAIL) results did not identify any substantial organizational risk factors. The senior leadership team was knowledgeable about selected SAIL metrics but should continue to take actions to improve care and performance of selected SAIL metrics, particularly Quality of Care and Efficiency metrics likely contributing to the “3-Star” rating. The OIG noted findings in one area of clinical operations reviewed and issued two recommendations. The identified area with deficiencies are: Medication Management: Controlled Substances Inspection Program • Annual physical security survey deficiencies • Controlled substances reconciliation

Some of the bonus payments that Alaska received for the audit period were not allowable in accordance with Federal requirements. Most of the data used in Alaska’s bonus payment calculations were in accordance with Federal requirements. However, Alaska overstated its fiscal years 2009 through 2013 current enrollment in its bonus requests to the Centers for Medicare & Medicaid Services (CMS) because it included individuals who did not qualify because of their basis-of-eligibility (BOE) category. CMS guidance instructed States to include in their current enrollment only individuals whom the State identifies and reports as having a BOE of "child" in the Medicaid Statistical Information System, which are BOE categories 4, 6, and 8. In addition to these three BOE categories, Alaska incorrectly included individuals from BOE 2, "Blind and Disabled."

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of Chillicothe VA Medical Center (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: Post-Traumatic Stress Disorder Care; Long-Term Care: Geriatric Evaluations; and Women’s Health: Mammography Results and Follow-Up. The Facility has stable executive leadership and active engagement with employees and patients as evidenced by high satisfaction scores. Organizational leaders appear to support patient safety, quality care, and other positive outcomes (such as initiating processes and plans to maintain positive perceptions of the Facility through active stakeholder engagement). The OIG’s review of accreditation organization findings, sentinel events, disclosures, and Patient Safety Indicator data results did not identify any substantial organizational risk factors. Although the leadership team was knowledgeable about selected Strategic Analytics for Improvement and Learning metrics and the Facility was rated as “5 Stars” for overall quality, the leaders should continue to take actions to sustain performance and to improve care and performance of poorer performing Quality of Care and Efficiency metrics. The OIG noted findings in two of the seven areas of clinical operations reviewed and issued two recommendations that are attributable to the Chief of Staff. The identified areas with deficiencies are: (1) Credentialing and Privileging • Focused Professional Practice Evaluations (2) Women’s Health: Mammography Results and Follow-Up • Electronic linking of mammogram results to the radiology order

HHS oversees States’ use of various Federal programs, including Medicaid. State agencies are required to establish appropriate computer system security requirements and conduct biennial reviews of computer system security used in the administration of State plans for Medicaid and other Federal entitlement benefits (45 CFR § 95.621). This review is one of a number of HHS, Office of Inspector General, reviews of States’ computer systems used to administer HHS-funded programs.

DHS did not comply with the Improper Payments Elimination and Recovery Act (IPERA) because it did not meet one of the six IPERA requirements. Specifically, DHS did not meet its annual reduction targets for 2 of 14 programs. Additionally, we determined that DHS did not provide adequate oversight of the component’s improper testing and reporting.