Federal Reports

Despite a continuous focus on improving its Improper Payments Elimination and Recovery Act of 2010 (IPERA) compliance program, the Corporation for National and Community Service (CNCS) remains unable to reliably estimate the amount or the rate of improper payments in the AmeriCorps State and National Program (AmeriCorps), Foster Grandparent Program (FGP), Retired and Senior Volunteer Program (RSVP), and Senior Companion Program (SCP). Specifically, we noted that the improper payments information reported in CNCS’s fiscal year (FY) 2017 Annual Management Report (AMR) is unreliable and incomplete; CNCS therefore did not comply with IPERA. As in the past, we identified flaws in multiple stages of CNCS’s improper payments assessment process; many of these flaws resulted from insufficient time and personnel to perform the FY 2017 IPERA testing.CNCS implemented a new alternative sampling methodology in FY 2017, as well as other corrective actions to address findings noted in the FY 2015 IPERA audit report. As a result of this progress, CNCS has met an additional OMB criterion for IPERA compliance, with two prior audit findings fully resolved in FY 2017. CNCS’s efforts also reduced the severity of some the issues, which are mainly limited to the sufficiency and adequacy of documentation as of FY 2017.However, these partial improvements did not substantially improve CNCS’s IPERA compliance, as CNCS did not meet four of the six OMB IPERA compliance criteria. Specifically, we identified the following compliance issues and other matters, all of which are recurring from the prior years:• CNCS did not properly identify improper payments, and the published improper payment estimates are not statistically valid, complete, or accurate. Specifically, we noted significant errors in CNCS’s sampling selection for its stratified sample and found that CNCS did not always follow, or document how it followed, its OMB-approved alternative sampling methodology.• CNCS did not fully comply with the IPERA risk assessment requirements, as it did not maintain documentation to support that it had performed additional procedures to verify that the FY 2015 risk assessment results were still valid for FY 2017.• CNCS did not meet its annual improper payment reduction targets for AmeriCorps, as the actual improper payment error rate reported was nearly twice the reduction target rate.• CNCS published an improper payment estimate that was greater than the acceptable threshold for IPERA compliance, or 10 percent, for three of its four programs (i.e., AmeriCorps, FGP, and SCP).Our report also notes other matters relating to CNCS’s ability to reduce and recapture improper payments, as follows:• CNCS did not adequately report on high-dollar overpayments, as it did not specify the risk-susceptible programs subject to high-dollar overpayments included in its report.• CNCS did not complete a cost-benefit assessment for payment recapture audits.• CNCS did not complete the reporting required as a result of its programs not complying with IPERA for three consecutive fiscal years.

The Office of Inspector General assessed NASA’s management of the Security Operations Center (SOC) located at Ames Research Center, which responds to Agency-wide security threats to NASA networks and IT systems.

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 Cincinnati VA Medical Center (the 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; Women’s Health: Mammography Results and Follow-Up; and High-Risk Processes: Central Line-Associated Bloodstream Infections. The OIG also provided crime awareness briefings to 111 employees. The Facility has generally stable executive leaders who were actively engaged with employees and patients and supported patient safety and quality care. The OIG’s review of accreditation organization findings, sentinel events, disclosures, 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 Quality of Care and Efficiency metrics likely contributing to the “4-Star” ranking. The OIG noted findings in four of the eight areas of clinical operations reviewed and issued seven recommendations that are attributable to the Director, Chief of Staff, and Associate Director. The identified areas with deficiencies are: 1) Quality, Safety, and Value • Documentation of patient safety events into the Patient Safety Information System 2) Credentialing and Privileging • Focused Professional Practice Evaluation and Ongoing Professional Practice Evaluation processes 3) Environment of Care • Attendance on environment of care rounds • Contamination prevention in equipment storage shelves 4) Medication Management: Controlled Substances Inspection Program • Controlled substances coordinator (CSC) duties included in Alternate CSC position description • Same-day completion of physical inventories of the controlled substances storage areas

At the request of Senator Sherrod Brown, the VA Office of Inspector General (OIG) conducted a follow-up healthcare inspection on clinical and administrative concerns at the Cincinnati VA Medical Center (facility), Ohio, that had been cited previously in reports by the OIG or the Veterans Health Administration’s Office of the Medical Inspector. The storage areas that the OIG team inspected were generally clean, with clean and dirty materials stored separately. Although the facility did not have a written policy or procedure for reporting reusable medical equipment reprocessing errors, an appropriate process, including an electronic tracking system, was in place. At the time of the OIG’s site visit in October 2017, the facility had adequately addressed these issues. The facility’s Methicillin-resistant Staphylococcus aureus (MRSA) surveillance and prevention activities appeared to be improving as the facility did not report new infections during the second half of fiscal year 2017. As of late January 2018, the facility was taking reasonable actions to prevent new MRSA infections. The facility has reportedly had difficulty recruiting and retaining Intensive Care Unit nurses because it is unable to meet salaries offered by other healthcare organizations. As of early February 2018, the facility was taking reasonable steps to ensure patient care and safety when Intensive Care Unit nurse staffing was not optimal, and to improve nurse recruitment and retention through pay parity efforts. The OIG made no recommendations.