Federal Reports

The VA OIG conducted a healthcare inspection to assess allegations of delays in providing patient test results, communication issues between providers and paramedics related to transporting patients to a community hospital emergency department, violations of the Emergency Medical Treatment and Labor Act, and quality of care concerns resulting from paramedic care at the Bath VA Medical Center (facility). The OIG substantiated a surrogate provider failed to follow test notification policies when a patient received positive stress test results 36 days after the test; however, the patient did not experience an adverse event as a result. The OIG substantiated a paramedic failed to comply with the facility’s standard operating procedure when the paramedic transported a patient to the nearest community hospital rather than one instructed by the provider. The provider recommended a hospital that was further because the nearest one lacked the necessary equipment to complete the patient evaluation. The OIG team noted that the facility’s transfer policy did not clearly define a process for outpatient transfers to a higher level of care utilizing facility paramedics. The OIG did not substantiate that facility paramedics violated the intent of the law by transporting patients to a community hospital emergency department. Facility providers medically screened and provided care to the patients prior to transfer. The OIG did not substantiate that facility paramedics provided poor quality of care to the reviewed patients. The paramedics asked suitable and clarifying questions of the providers, assessed the patients, and documented their findings. The OIG made two recommendations to the Facility Director to ensure that surrogate providers comply with their responsibilities to notify patients of test results when providing coverage and to ensure that the Patient Transfer Policy clearly defines a process for outpatient transfers to a higher level of care utilizing facility paramedics.

The enclosed report presents the results of the audit of the Commission’s financial statements for the fiscal year ended September 30, 2019

The Coverage Gap Discount Program (CGDP) made manufacturer discounts equal to 50 percent of the negotiated price of applicable, covered Part D drugs available to Medicare Part D beneficiaries during calendar years (CYs) 2011 through 2018. During CYs 2013 and 2014, Coverage Gap discounts totaled more than $4.5 billion and $4.7 billion, respectively.

The U.S. Department of Health and Human Services (HHS), National Institutes of Health (NIH), is subject to Federal audits of its internal activities as well as Federal and non-Federal audits of activities performed by its grantees and contractors. As a followup to these audits, NIH is responsible for resolving Federal and non-Federal audit report recommendations related to its activities, grantees, and contractors within 6 months after formal receipt of the audit reports. HHS, Office of Inspector General (OIG), prepares and forwards to NIH monthly stewardship reports that show the status of these reported audit recommendations.

An Amtrak senior employee in Los Angeles, California, was terminated from employment on January 21, 2020, and a Los Angeles-based senior employee in Mechanical Operations was issued a written reprimand on the same date following the issuance of our investigative report. Our investigation found that the senior employee solicited money and accepted gifts from company contractors. Our investigation also found that the senior employee in Mechanical Operations misused company equipment and email when proposing a personal business venture with a company contractor.

Although the Imperial Regional Detention Facility (IRDF) generally complied with the U.S. Immigration and Customs Enforcement (ICE) detention standards regarding classification of detainees according to risk, it did not meet the standards for segregation, facility condition, medical grievances, and detainee communication. We determined detainees were held in administrative segregation for prolonged periods of 22-23 hours per day, including two detainees who had been held in isolation for more than 300 days. We also determined that parts of the facility were in poor condition, medical checks were insufficient to ensure proper detainee care, medical grievances and responses were not properly documented, and ICE communication with detainees was limited. Until ICE takes corrective action to address these violations of detention standards, the facility will be unable to ensure an environment that protects the health, safety, and rights of detainees. We made six recommendations to ICE’s Executive Associate Director of Enforcement and Removal Operations (ERO) to ensure the San Diego ERO Field Office overseeing IRDF addresses identified issues and ensures facility compliance with relevant detention standards. ICE concurred with all six recommendations and is implementing a corrective action plan to address the concerns identified.