Federal Reports

We determined that while the Commission has a system in place to account for funds on a project-by-project basis and generally expended Public Assistance grant funds according to FEMA guidelines, the Commission needs additional assistance in developing long-term solutions for repetitive damages to county roads and managing its $5.4 million FEMA grant. We found that the Commission did not receive adequate guidance from FEMA and Alabama concerning Hazard Mitigation funding for long-term solutions to repetitive damages to roads; thus, potentially costing FEMA millions of dollars in the future; and project formulation, causing improperly written project scopes. Additionally, the Commission did not have proper procurement procedures to ensure that small businesses, minority-owned firms, and women’s business enterprises have an opportunity to bid on Federal contracts; and adequate procedures to ensure proper documentation is collected to support $24,000 in costs. The report contains five recommendations to the Regional Administrator, FEMA Region IV, to provide the Commission with additional guidance to properly manage its $5.4 million and save millions in the future. FEMA agreed with all recommendations.

This study continues OIG's body of work examining overpayments made by Medicare. Overpayments can be identified by a number of key players including providers and Medicare contractors. Recovering overpayments is critical to reducing improper payments in the Medicare program. Past OIG work found that overpayments referred by program safeguard contractors (PSCs) for collection did not result in significant recoveries to the Medicare program. As of 2012, CMS had transitioned the workload of most PSCs to six zone program integrity contractors (ZPICs). In 2016, CMS began transitioning the remaining PSCs and ZPICs to unified program integrity contractors (UPICs). OIG's work on both PSCs and ZPICs identified deficiencies in how contractors were tracking and reporting overpayment data. This study provides an update on the collection of ZPIC- and PSC-referred overpayments and identifies ongoing challenges that contractors face in tracking and collecting overpayments identified by ZPICs and PSCs.

The OIG reviewed allegations the Veterans Health Administration (VHA) inappropriately used Government purchase cards to procure commonly used prosthetics, instead of establishing contracts to leverage VHA’s purchasing power, and failed to ensure fair and reasonable prices. Furthermore, VHA allegedly did not report purchases in the Federal Procurement Data System (FPDS). We substantiated the allegation that for some prosthetic purchases above the micro-purchase limit, VHA did not leverage its purchasing power by establishing contracts and did not ensure fair and reasonable prices. This occurred because VHA controls did not ensure the Prosthetic and Sensory Aids Service (PSAS) sufficiently analyzed prosthetic purchases to identify commonly used prosthetics and the Procurement and Logistics Office (P&LO) did not adequately monitor Network Contracting Office procurement practices to ensure contracts were established. We estimated VHA may have paid higher prices for an estimated $256.7 million in prosthetics purchases during fiscal year (FY) 2015 by not establishing contracts.We did not substantiate the allegation that VHA failed to report prosthetic procurements in FPDS. However, we determined VA medical facility staff improperly procured prosthetics above the micro-purchase limit without authority. We estimated VHA made improper payments and unauthorized commitments totaling about $520.7 million in FY 2015. If VHA staff does not ensure P&LO and PSAS implement our recommendations and newly established controls, they increase risks for improper payments and unauthorized commitments totaling about $2.6 billion over a five-year period.We recommended the Acting Under Secretary for Health take additional actions to identify all commonly used prosthetics offering opportunities for leveraging VHA’s purchasing power and pursue appropriate contracts. We also recommended the Acting Under Secretary review FYs 2015 and 2016 prosthetics transactions to identify unauthorized commitments for ratification, conduct annual reviews, and consider holding cardholders and their approving officials accountable for unauthorized commitments, as appropriate.

CNCS-OIG received an allegation that a CNCS State Program Officer may have falsified documents when she awarded a VISTA grant.The investigation found no evidence that the employee falsified documents pertaining to the awarding of the VISTA grant; however, the employee failed to follow the VISTA Desk Reference guidelines when she failed to obtain the proper documents and verify the 501(c) (3) nonprofit status before awarding the VISTA grant.

OIG conducted a healthcare inspection to assess allegations made regarding the management of outpatient post-traumatic stress disorder (PTSD) consults by the PTSD Clinical Team (PCT) at Battle Creek VA Medical Center (facility), Battle Creek, MI.Specifically the complainant alleged:• Between May and July 2016, consults were improperly designated as complete although a PCT provider had not evaluated the patient.• A mental health provider used computer-based and written psychological testing as a substitution for evaluations.• Staff psychologists were unproductive.We substantiated that some PCT consults were improperly identified as completed between May 1 and July 30, 2016. We substantiated that four of the five identified patients had PCT consults inappropriately designated as complete roughly between May 1 and July 30, 2016. In spring 2016, PCT managers changed their assessment process to include multiple clinic visits rather than a single one. The change caused confusion relating to when a consult was considered complete. We reviewed the care of all patients who received a PCT consult between January 1 and March 31, 2016, before the process change, and between May 1 and July 30, 2016, after the process change. We found 37 of the 111 (33 percent) consults were marked as completed prior to the assessment process with a provider. However, we did not find any of the patients suffered adverse clinical impact. We confirmed that PCT managers decided to return the PCT consult process to its previous operation prior to our site visit in August 2016. In that the consult scheduling process was corrected and we found no adverse impact to patients, we made no recommendation. We did not substantiate a mental health provider used computer-based and written psychological testing as a substitution for an evaluation or that psychologists had nonproductive work hours during the new scheduling process.We made no recommendations.