Federal Reports

Prior OIG audits identified Medicare overpayments to hospitals that did not comply with Medicare's post-acute-care transfer policy (transfer policy). CMS generally concurred with our recommendations, but subsequent analysis that we conducted indicated that CMS's system edits were still not properly designed and that hospitals may be using condition codes to bypass CMS's system edits to receive higher reimbursements for inpatients transferred to home health services.

What We Looked AtWe queried and downloaded 95 single audit reports prepared by non-Federal auditors and submitted to the Federal Audit Clearinghouse between April 1, 2020 and June 30, 2020, to identify significant findings related to programs directly funded by the Department of Transportation (DOT). What We FoundWe found that reports contained a range of findings that impacted DOT programs. The auditors reported significant noncompliance with Federal guidelines related to 21 grantees that require prompt action from DOT’s Operating Administrations (OA). The auditors also identified questioned costs totaling $3,440,165 for 10 grantees. RecommendationsWe recommend that DOT coordinate with the impacted OAs to develop a corrective action plan to resolve and close the findings identified in this report. We also recommend that DOT determine the allowability of the questioned transactions and recover $3,440,165, if applicable.

The VA Office of Inspector General (OIG) received allegations of inadequate orientation and training of pharmacy staff, a lack of pharmacist oversight of intravenous (IV) admixtures, and noncompliance with controlled substance policies. The Veterans Integrated Service Network Director initially reviewed the matter and did not substantiate the allegations but noted that some pharmacy staff’s annual IV compounding competencies had lapsed. The OIG received a second allegation that pharmacy management was noncompliant with Veterans Health Administration (VHA) controlled substance policies and initiated a healthcare inspection to evaluate the allegations and review the annual IV compounding competencies. The OIG did not substantiate inadequate pharmacist orientation and training for inpatient pharmacy, IV admixture, and the cache, and did not substantiate a lack of pharmacist oversight in technician-prepared IV admixtures. The annual required staff competencies were current. However, the OIG team noted the orientation checklists and annual competencies lacked a tracking mechanism. Pharmacy managers complied with the VHA controlled substance directive. The OIG team learned of a suspected controlled substance diversion incident that facility leaders reported to the VA police and the OIG Office of Investigations but did not report to the email group required by the VHA directive at the time. The OIG team learned of an instance where testosterone was not added to inventory records or secured in the vault. The OIG made three recommendations to the Facility Director related to developing a tracking process for orientation and annual competencies of pharmacy staff, ensuring facility leaders are trained on current VHA drug diversion reporting requirements, and conducting a review of the testosterone misplacement. Note: This matter is not related to the recent criminal case involving a former nursing assistant at the Louis A. Johnson VA Medical Center in Clarksburg, West Virginia.

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the William S. Middleton Memorial Veterans Hospital and multiple outpatient clinics in Illinois and Wisconsin. The inspection covers key clinical and administrative processes that are associated with promoting quality care. For this inspection, the areas of focus were Leadership and Organizational Risks; Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; Medication Management: Long-Term Opioid Therapy for Pain; Mental Health: Suicide Prevention Program; Care Coordination: Life-Sustaining Treatment Decisions; Women’s Health: Comprehensive Care; and High-Risk Processes: Reusable Medical Equipment. The executive leadership team appeared stable, with all positions assigned. Survey results indicated that employees were generally satisfied and seemed consistent with the medical center’s high-performing Best Place to Work performance measure. Patient survey results were notably higher than corresponding VHA averages; however, female patients were generally less satisfied. The OIG identified concerns with poor communication among program leaders as a vulnerable area for the medical center. Executive leaders were generally knowledgeable about Strategic Analytics for Improvement and Learning measures and should continue to take actions to improve and sustain performance. The OIG issued 16 recommendations for improvement in six areas: (1) Quality, Safety, and Value • Improvement action implementation • Utilization management data review (2) Medical Staff Privileging • Professional practice evaluation processes • Provider exit review forms (3) Environment of Care • Medical equipment inspections • Medication storage (4) Medication Management • Behavior risk assessment • Urine drug testing • Informed consent • Patient follow-up after therapy initiation (5) Mental Health • Staff training (6) High-Risk Processes • Annual risk analysis • Traffic flow restriction • Temperature and humidity monitoring • Staff competency and continuing education

The Social Security Act requires that each Medicare administrative contractor (MAC) have its information security program evaluated annually by an independent entity. The Centers for Medicare & Medicaid Services (CMS) contracted with Guidehouse, LLP (Guidehouse), to evaluate information security programs at the MACs, using a set of agreed-upon procedures (AUPs). HHS OIG must submit to Congress annual reports on the results of these evaluations, to include assessments of their scope and sufficiency. This report fulfills that responsibility for fiscal year 2019.