Federal Reports

OIG conducted a healthcare inspection in response to allegations from anonymous complainant(s) regarding the quality of care provided by a thoracic surgeon at the Bay Pines VA Healthcare System (system), Bay Pines, FL. We did not substantiate that the thoracic surgeon was incompetent. However, we identified a deficiency in the system’s process for evaluating surgeons’ competency. Contrary to VA policy, the criteria used in focused professional practice evaluations (FPPE) were not privilege-specific and inadequate to fully assess a provider’s skills. An August 2016 Deputy Under Secretary for Health for Operations and Management memorandum specified that as of August 2017, a provider with similar training and privileges should conduct ongoing professional practice evaluations (OPPE). The surgeon’s OPPE that we reviewed had been completed prior to the August 2016 DUSHOM memorandum and was done by an administrative psychiatrist.We did not substantiate that the surgeon had a high rate of complications. We did not identify specific quality of care concerns in the surgeon’s mortality cases we reviewed. The anonymous complainant(s) provided nine specific patient cases. We consulted with a thoracic surgeon who did not identify quality of care concerns for the nine patients. We also identified six deaths occurring within 30 days of a thoracic surgical procedure. We did not identify quality of care concerns with these cases. We substantiated that the thoracic surgeon requested the critical care team not care for his patients related to disagreements about fluid management. We determined that he had the authority to do so under the system’s policy.We could not substantiate that surgeons left the system because of quality of care concerns related to the thoracic surgeon, or that the Chief of Staff and/or System Director were aware of concerns regarding the thoracic surgeon’s competence yet failed to address them. We made two recommendations.

HHS oversees States' administration of various Federal programs, including Medicaid. State agencies are required to establish appropriate computer system security requirements and conduct biennial reviews of computer system security used in the administration of State plans for Medicaid and other Federal entitlement benefits. This review is one of a number of HHS OIG reviews of States' computer systems used to administer HHS-funded programs. Our objective was to determine whether the North Carolina had implemented adequate information system general controls over the North Carolina Medicaid claims processing systems in accordance with Federal requirements.