Federal Reports

Our objective was to identify opportunities to improve Surface Visibility (SV) scan compliance at Postal Service processing and distribution centers (P&DCs) in the Capital Metro Area and summarize our prior Western Area SV scanning audit work. This is our second and final report examining SV scanning compliance. We selected the Capital Metro Area for this audit because from fiscal year (FY) 2015, Quarter (Q) 4, to FY 2017, Q4, its average scan compliance rate was about 82 percent, the lowest in the nation. We selected two high-performing sites and two low-performing sites based on their FY 2017 scan compliance, as of July 21, 2017, to identify best practices.

The Indian Health Service's (IHS) travel card program, under which IHS employees are to use Government charge cards for nearly all payments of expenses related to official Government travel, did not always comply with Federal requirements and IHS's own policy. We identified 16 transactions (out of the 151 sampled transactions we tested) that did not comply with Federal requirements and IHS policy regarding proper travel card use. These errors occurred because, although IHS had controls in place to educate cardholders on the requirements for the use of the travel card, the controls did not always prevent misuse of the travel card. Additionally, whereas IHS had controls in place to monitor cardholders, those controls did not always identify noncompliance.

The Centers for Medicare & Medicaid Services (CMS) had policies and procedures in place that were generally effective in ensuring that capitation payments to Medicare Advantage organizations' prescription drug plans and stand-alone prescription drug plans (collectively referred to as "sponsors") for Medicare Part D coverage were not made on behalf of deceased beneficiaries after the individuals' dates of death. These policies and procedures generally ensured that CMS did not make improper capitation payments on behalf of deceased beneficiaries when its data systems indicated at the time of a monthly capitation payment that the beneficiaries in question had died.

The VA Office of Inspector General (OIG) initiated and conducted a study to assess whether VA providers established androgen deficiency (lower levels of male sex hormones, particularly testosterone, than is needed for health) prior to initiating testosterone therapy and the extent VA providers performed follow-up evaluation after initiating the therapy, in accordance with the 2010 Endocrine Society Clinical Practice Guidelines and current VA criteria for use. The OIG found that VA providers generally did not follow Endocrine Society Clinical Practice Guidelines and current VA criteria for use when initiating patients with testosterone replacement therapy or following up with patients within 3–6 months after therapy initiation. VA providers largely did not document clinically significant signs and symptoms consistent with androgen deficiency before initiating therapy or before performing biochemical confirmatory testosterone level tests. This suggests VA providers might have used testosterone tests to screen for, rather than to confirm, androgen deficiency. In addition, VA providers generally did not perform both follicle-stimulating hormone and luteinizing hormone tests to distinguish between primary and secondary androgen deficiency before initiating testosterone replacement therapy. VA providers did not document a discussion of the risks and benefits of testosterone replacement therapy with approximately two out of three patients before therapy initiation. After testosterone replacement therapy initiation, VA providers did not conduct follow-up evaluation within 3–6 months for about two out of three patients before continuing the therapy. The OIG made seven recommendations to the Under Secretary for Health to ensure that providers are in alignment with Veterans Health Administration current guidance related to the initiation and maintenance of testosterone replacement therapy.

The Federal Information Security Modernization Act of 2014 (FISMA) requires each federal agency to develop, document, and implement an agencywide information security and risk management program. VA has made progress producing, documenting, and distributing policies and procedures as part of its program. VA still faces challenges, however, implementing components of its agencywide information security risk management program to meet FISMA requirements. This audit identified continuing significant deficiencies related to access, configuration management, and change management controls, as well as service continuity practices designed to protect mission-critical systems from unauthorized access, alteration, or destruction. The report includes 29 recommendations for improving VA’s information security program and an appendix addressing the status of prior recommendations and VA’s plans for corrective action. VA successfully closed four recommendations in FY 2017. The Executive in Charge for the Office of Information and Technology generally concurred with the recommendations and submitted adequate corrective action plans. The OIG will continue to evaluate VA’s progress during its audit of VA’s information security program in FY 2018, although the OIG remains concerned that ongoing delays in implementing effective corrective actions might contribute to the continued reporting of an information technology material weakness in this year’s audit of VA’s Consolidated Financial Statements.

The OIG investigated allegations that tribal officials manipulated statistical reports they submitted to the Bureau of Indian Affairs (BIA) to influence the amount of Federal funding received by the tribe. We also investigated allegations that tribal officials distributed Federal grant funds to ineligible clients, and that they terminated a former employee for notifying the BIA of potential fraudulent activities.We did not substantiate any of the allegations. We confirmed with BIA officials that the statistical reports they received from the tribe were accurate and did not have any effect on Federal funding to the tribe.We did find that tribal officials spent Federal grant funds to pay for a local cultural workshop that included some ineligible participants, however the Tribe subsequently used non-Federal tribal funds to fully reimburse the grant for the cost of the entire workshop.We found the former employee who claimed retaliation was employed in a temporary position which had expired. The tribe did not extend the terms of the position because the employee failed to meet the requirements for the position, and because their services were no longer needed.