Federal Reports

Federal law requires that each Medicare administrative contractor (MAC) have its information security program evaluated annually by an independent entity, and these evaluations must address the eight major requirements enumerated in the Federal Information Security Management Act of 2002 (FISMA). To comply with this provision, CMS contracted with PricewaterhouseCoopers (PwC) to evaluate information security programs at the MACs using a set of agreed-upon procedures. The Office of Inspector General must submit to Congress annual reports on the results of these evaluations, to include assessments of their scope and sufficiency. This report fulfills that responsibility for fiscal year 2016.

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 VA Black Hills Health Care System (facility). The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality, Safety, and Value; Medication Management: Anticoagulation Therapy; Coordination of Care: Inter-Facility Transfers; Environment of Care (EOC); High-Risk Processes: Moderate Sedation; and Post-Traumatic Stress Disorder Care. OIG also provided crime awareness briefings to 151 employees.Organizational leadership supports patient safety, quality care, and other positive outcomes; however, the facility leaders have opportunities to improve employee satisfaction. 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. Although the senior leadership team was knowledgeable about selected SAIL metrics, the leaders should continue to take actions to improve performance of the Quality of Care and Efficiency metrics likely contributing to the current 4-star SAIL rating. OIG noted findings in three of the six areas of clinical operations reviewed and issued six recommendations that are attributable to the Facility Director, Chief of Staff, and Associate Director. The identified areas with deficiencies are:(1) Coordination of Care: Inter-Facility Transfers• Inter-facility patient transfer data analysis and reporting(2) EOC• EOC rounds attendance• Locked mental health (MH) unit environmental safety• Locked MH unit employee and Interdisciplinary Safety Inspection Team training(3) High-Risk Processes: Moderate Sedation• Assessment of patients’ previous adverse experiences with sedation• Use of checklist for timeout procedure

At the request of former United States Senator Harry Reid, the Office of Inspector General (OIG) reviewed allegations of excessive rent and remodeling costs, lack of radiology services, and inadequate handicap accessibility at the Master Chief Petty Officer Jesse Dean VA Clinic (clinic), which provides primary care to approximately 1,372 veterans in and around Laughlin, Nevada. The OIG found that VA paid excessive lease costs for the clinic when it awarded a 10-year contract at a rate higher than the established fair rental value (FRV). Additionally, VA paid for shell improvement costs for the clinic, which were the lessor’s responsibility. The contract file had no documents to explain or justify the lease’s higher rate, nor was there evidence of any reviews having occurred prior to awarding the lease. As a result, VA may pay as much as 41 percent above FRV over the 10-year lease. The OIG did not substantiate other allegations related to remodeling costs, radiology services, or clinic accessibility. The OIG recommended that VA ensure oversight reviews are conducted and documented prior to the award of leases, contracting officers adhere to acquisition requirements, and awarded lease rates are in the best interest of the government. The OIG also recommended that VA reevaluate the lease to determine the financial advantages and disadvantages of renegotiating the terms of the contract to obtain a FRV commensurate with the Laughlin area.