Federal Reports

What We Looked AtThe Airline Deregulation Act of 1978 (ADA) gave airlines the freedom to determine which markets to serve and what fares to charge. However, it also raised concerns that communities with relatively low traffic levels might lose service entirely if carriers shifted their operations to larger, potentially more lucrative markets. Through the Essential Air Service (EAS) Program, the Department of Transportation (DOT) determines the requirements for each eligible community and subsidizes air carriers when necessary. In 2018, Congress directed our office to determine whether DOT was providing sufficient oversight of the unsubsidized air carriers providing basic essential air service. Accordingly, our objectives were to evaluate whether DOT (1) appropriately relied on unsubsidized air carriers for small communities and (2) conducted oversight of the services provided by those air carriers. What We FoundDOT appropriately relied on unsubsidized air carriers in accordance with its policy. Specifically, if an air carrier proposed to provide air service without a subsidy and the Department determined the carrier could reliably do so, DOT relied on the carrier’s service as proposed. Federal law does not require DOT to consider community views when it relies on unsubsidized carriers, and the Department did not prescribe specific content for their proposals. We also found that DOT conducted limited oversight of the EAS communities served by unsubsidized carriers. Federal law requires eligible communities to be provided with basic essential air service and air carriers to file a 90-day notice of their intent to end, suspend, or reduce such service. While unsubsidized carriers typically met the minimum departure criteria for their communities, officials in seven of the nine communities we reviewed were unaware that they could petition Department when issues arose. DOT also did not conduct required periodic reviews of the designated levels of service in unsubsidized communities, which limited its awareness of their essential air service needs. Our RecommendationsWe made two recommendations to improve DOT’s oversight of EAS communities served by unsubsidized carriers. The Department concurred with recommendation 1 and partially concurred with recommendation 2, which we consider to be open and unresolved pending a decision from DOT.

In 2020, the Veterans Benefits Administration (VBA) processed about 1.2 million disability compensation claims and paid more than $90.8 billion in total benefits to veterans. About five million veterans were receiving these benefits as of December 31. To ensure claims decisions are accurate and consistent so veterans receive the benefits to which they are entitled, VBA established a multifaceted quality assurance program.The VA Office of Inspector General (OIG) reviewed the quality assurance program and identified a systemic weakness in oversight and accountability. In the quality assurance program, Compensation Service conducts reviews that identify deficiencies in the disability compensation benefits claims process, and the Office of Field Operations has oversight responsibility for ensuring regional office employees and supervisors follow quality assurance procedures and take action to correct deficiencies identified during quality assurance reviews. The OIG found that while VBA’s quality assurance program routinely identified claims-processing deficiencies and communicated results to internal and external stakeholders, the Office of Field Operations did not ensure that regional office employees took adequate corrective actions to address the deficiencies identified.Until VBA senior leaders ensure improvements are made, veterans are at risk of not receiving the benefits they deserve. The OIG recommended the acting under secretary for benefits develop and implement a written plan to strengthen oversight of the quality assurance program and monitor the plan to ensure identified deficiencies are adequately addressed.

The VA Office of Inspector General (OIG) conducted an inspection in response to allegations related to ophthalmology resident supervision and quality of care by an attending ophthalmologist (subject ophthalmologist) at the Oklahoma City VA Health Care System in Oklahoma.The OIG substantiated that the subject ophthalmologist failed to provide adequate resident supervision and entered inaccurate documentation related to supervision for a single patient case. The ophthalmology residents were unable to reach the subject ophthalmologist when the patient experienced a complication during an eye injection procedure. The residents reached another attending ophthalmologist who examined the patient and assisted the residents.The subject ophthalmologist was assigned to supervise residents in the clinic and did not arrange a hand-off for attending coverage when away from the clinic.The OIG found that a note in the patient’s electronic health record that documented supervision by the subject ophthalmologist was incorrect because the subject ophthalmologist did not directly participate in and was not present during the care of the patient. The subject ophthalmologist used a standard template and acknowledged the note was incorrect due to a failure to read and edit the note before signing it.Aside from the single patient case, the OIG did not identify other failures to supervise residents or inaccurate documentation of resident supervision by the subject ophthalmologist.The subject ophthalmologist, aside from the single patient case, provided and documented proper patient care. A review of 20 patients performed by an external ophthalmologist and the OIG determined the subject ophthalmologist provided acceptable quality of care and appropriate documentation.The OIG made three recommendations to the Facility Director related to documentation of resident supervision and the hand-off process for attending ophthalmologist coverage.