Federal Reports

The Office of Inspector General (OIG) Vet Center Inspection Program provides a focused evaluation of aspects of the quality of care delivered at vet centers. This report focuses on Southeast district 2 zone 2 and four selected vet centers: Clearwater, Ocala, and Sarasota in Florida; and Ponce in Puerto Rico. The OIG inspection focused on six review areas: leadership and organizational risks; quality reviews; COVID-19 response; suicide prevention; consultation, supervision, and training; and environment of care.Generally, district leaders had a good understanding of quality improvement principles and implemented district-wide quality improvement programs in response to VA All Employee Survey results. District 2 zone 2 Vet Center Service Customer Feedback survey results exceeded national scores. The OIG conducted an analysis of vet center quality reviews required to ensure compliance with policy and procedures. The OIG made four recommendations for clinical and administrative quality reviews and two recommendations for critical incident quality reviews. The COVID-19 response review showed that although initially feeling ill-equipped, district leaders enacted emergency plan procedures and vet centers remained operational. Employees’ response to an OIG questionnaire indicated the pandemic response was well managed by district leaders and vet center directors. The suicide prevention review included a zone-wide evaluation of electronic client records, and a focused review of the four selected vet centers. The OIG issued 10 recommendations—four specific to client records and six for selected vet centers’ suicide prevention and intervention processes. The consultation, supervision, and training review evaluated the four vet centers. The OIG identified concerns with external clinical consultation, supervision, and training, and issued four recommendations. The environment of care review evaluated the four vet centers. The OIG made two recommendations.The OIG issued a total of 22 recommendations for improvement, including three to the Under Secretary for Health and 19 to the District Director.

The VA Office of Inspector General (OIG) Vet Center Inspection Program provides a focused evaluation of aspects of the quality of care delivered at vet centers. This report focuses on Continental district 4 zone 2 and four selected vet centers: Alexandria in Louisiana and Houston Southwest, Laredo, and Mesquite in Texas. The OIG inspection focused on six review areas: leadership and organizational risks; quality reviews; COVID-19 response; suicide prevention; consultation, supervision, and training; and environment of care.Generally, district leaders were knowledgeable about quality improvement principles and implemented district-wide quality improvement programs in response to VA All Employee Survey results. District 4 zone 2 Vet Center Service Customer Feedback survey results exceeded national scores.The OIG conducted an analysis of vet center quality reviews required to ensure compliance with policy and procedures. The OIG made three recommendations for clinical and administrative quality reviews and two recommendations for critical incident quality reviews.The COVID-19 response review showed district leaders adjusted and figured out what needed to be done to ensure vet centers remained operational. Employees’ response to an OIG questionnaire indicated district leaders and vet center directors were prepared and provided communication to ensure employee and client safety.The suicide prevention review included a zone-wide evaluation of electronic client records, and a focused review of the four selected vet centers. The OIG issued eight recommendations—seven specific to electronic client records and one for selected vet centers’ suicide prevention and intervention processes.The consultation, supervision, and training review evaluated the four selected vet centers, identified concerns with external clinical consultation, supervision, and training, and issued four recommendations.The environment of care review evaluated the four selected vet centers and made three recommendations.The OIG issued a total of 20 recommendations for improvement.

The VA Office of Inspector General (OIG) Vet Center Inspection Program provides a focused evaluation of aspects of the quality of care delivered at vet centers. This report focuses on Pacific district 5 zone 1 and four selected vet centers—Bellingham and Tacoma in Washington, Central Oregon in Bend, and Wasilla in Alaska. The OIG inspection focused on six review areas: leadership and organizational risks; quality reviews; COVID-19 response; suicide prevention; consultation, supervision, and training; and environment of care.Overall, district leaders had a good understanding about quality improvement principles and implemented district-wide quality improvement programs in response to VA All Employee Survey results. District 5 zone 1 Vet Center Service Customer Feedback survey results were favorable in five of six areas.The OIG conducted an analysis of vet center quality reviews required to ensure compliance with policy and procedures. The OIG made three recommendations for clinical and administrative quality reviews and one recommendation for critical incident quality reviews.The COVID-19 response review showed district leaders were as prepared as possible and able to enact emergency plan procedures to ensure vet centers remained operational. Employees’ response to an OIG questionnaire reflected that communication from district leaders and vet center directors was adequate to ensure the safety of clients and staff.The suicide prevention review included a zone-wide evaluation of electronic client records and a focused review of the four selected vet centers. The OIG issued 11 recommendations addressing eight zone-wide and three selected vet centers’ suicide prevention and intervention processes.The consultation, supervision, and training review evaluated the four selected vet centers, identified concerns with clinical liaison, external clinical consultation, supervision, monthly audits, and training, and issued five recommendations.The environment of care review evaluated the four selected vet centers and made three recommendations.The OIG issued 23 recommendations for improvement.

FY 2021 Report on the FTC’s Top Management and Performance Challenges

The Semiannual Report to Congress summarizes the key audits, evaluations, and investigative works the Office of Inspector General (OIG) completed during the 6-month period ending September 30, 2021. Over the past 6 months, OIG issued 11 products related to its audit, evaluation, and inspection work. These products addressed programs and personnel associated with the U.S. Census Bureau, National Institute of Standards and Technology, National Oceanic and Atmospheric Administration (NOAA), United States Patent and Trademark Office, and the Department itself. This report also describes OIG’s investigative activities addressing programs and personnel associated with the U.S. Census Bureau, U.S. Economic Development Administration, NOAA, and the Department itself. OIG encourages employees and others to continue to promote accountability by reporting concerns about fraud, waste, abuse, and mismanagement to the OIG hotline.