Federal Reports

OIG conducted a healthcare inspection to assess whether safety screenings were performed and documented prior to magnetic resonance imaging (MRI) at the Central Alabama Veterans Health Care System (system), Montgomery, AL. The system has an agreement with a Department of Defense clinic, Lyster Army Health Clinic (Lyster), for MRI services. Lyster staff do not have access to VA electronic health records (EHRs) and system staff do not have access to Lyster EHRs. A powerful magnetic field around MRI scanners creates safety risks. Safety screening is critical to alert staff of patients’ electronic, mechanical, or magnetic implants. VHA requires pre-MRI initial and secondary safety screenings. We did not find a VHA or system policy addressing documentation requirements of MRI safety screening forms completed at non-VA facilities. We reviewed 158 of 2,753 MRI orders (6 percent) completed at the system or at Lyster from September 22, 2014 through September 22, 2015, to assess documentation of initial and secondary safety screenings. In September 2015, the system took steps to ensure that staff completed initial safety screening forms when the MRI was ordered for patients receiving MRIs at Lyster. We found 17 patients who received MRIs at Lyster without initial safety screenings. However, Lyster staff had completed and documented the secondary safety screenings in the Lyster EHRs, and completed the MRIs. We reviewed the 158 patients for secondary screenings. Secondary safety screening forms were not available in VHA EHRs but were in the Lyster EHRs; copies of the completed forms would be made available upon request. To evaluate safety screening documentation after September 2015, we reviewed 50 of 475 MRI orders (10.5 percent) placed in July 2016. Ten of the 50 were excluded. We found that the remaining MRI orders included the initial safety screening in the VHA EHR.

OIG evaluated controls over the health care enrollment program administered at VA medical facilities and determined if enrollment actions were processed timely and supported by required documentation. OIG found that VHA did not provide effective governance necessary to ensure oversight and control over the health care enrollment program medical facilities. Specifically, VHA required medical facilities to establish procedures for processing enrollment applications without implementing effective processes to monitor those activities. Only 38 of 106 VA medical facilities sampled had local enrollment policies. Medical facilities that did have guidance were permitted to adopt practices that were inconsistent with national policies. Conflicts between local practices and national policies occurred because VHA lacked appropriate guidance, oversight, and monitoring to ensure a standardized enrollment process. Formal training was also not provided to eligibility and enrollment staff at VA medical facilities. OIG also found that data systems did not have the capability to identify new enrollment applications or provide the basis for independent testing of timeliness or supporting documentation. Based on a statistical sample, OIG projected that only 197,000 of 427,000 enrollment records in the universe represented FY 2015 applications for enrollment. Further, OIG could not make conclusions related to timeliness or supporting documentation. This occurred because VHA did not adequately monitor program effectiveness or ensure that accurate data were available for program transparency. OIG recommended VHA develop standardized national policy and procedures, implement national oversight, and provide mandatory and standardized training for the health care enrollment program at VA medical facilities. OIG also recommended VHA implement a plan to correct the data integrity issues necessary to improve the accuracy and timeliness of health care enrollment data.

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Not all of the direct medical service costs that the Texas Health and Human Services Commission (State agency) claimed for Medicaid School Health and Related Services (SHARS) were reasonable, adequately supported, and otherwise allowable in accordance with applicable Federal and State requirements. Specifically, Fairbanks, LLC (the Contractor), coded random moments incorrectly. Of the 3,161 random moments coded as an Individualized Education Plan-covered direct medical service, 274 were coded incorrectly. As a result of these errors, the State agency received $18.9 million in unallowable Federal reimbursement for the Medicaid SHARS program during the period October 1, 2010, through September 30, 2011.