Federal Reports

The VA Office of Inspector General (OIG) conducted an inspection related to a patient’s emergent mental health services, medication management, and emergency procedures at the facility. The inspection team identified an additional concern related to the Recovery and Engagement and Coordination for Health—Veterans Enhanced Treatment (REACH VET) program. The patient was a former service member who was granted 90 days of Veterans Health Administration (VHA) emergent mental health services due to other than honorable discharge (OTH) status. The OIG found that VHA did not provide written guidance on expected timeframes and patient notification processes regarding emergent mental health services extension requests. Facility staff notified the patient of the extension request denial two days prior to the patient’s eligibility ending. The Chief of Staff failed to review treatment notes and submit the extension request to the Veterans Integrated Service Network Chief Medical Officer, as required. The OIG team did not substantiate that facility providers discontinued the patient’s Suboxone® and other medications without a taper or transition to another program. Grant and Per Diem Program staff were instructed to call 911 rather than facility code blue for patients with OTH discharge status, which may result in disparity of care. The OIG reviewed the care of five patients with OTH discharge status who were also identified by the REACH VET program. Facility staff failed to follow up with one patient who was identified by the REACH VET program twice after the emergent mental health services eligibility ended. The patient died by suicide approximately three months later. The OIG made two recommendations to the Under Secretary for Health related to emergent mental health services and the REACH VET program and two recommendations to the Facility Director related to emergent mental health services and medical emergency procedures.

The OIG performed a risk assessment of VA’s grant closeout process to determine if an audit or review of VA’s process was warranted, as required by the Grants Oversight and New Efficiency Act of 2016. The act also required agencies to report on grants that were expired for more than two years that had not been closed out, and to report challenges leading to delays in closing such grants. Given these requirements, the assessment team focused on the timeliness of grant closeouts at VA. The team considered the number of open grants expired for more than two years, the relative size of their undisbursed balances compared to their respective grant programs, and the relative size of these grant programs to VA’s overall budget. VA reported 34 expired grants more than two years old with undisbursed balances as of the end of 2019. The reported undisbursed balances for these open but expired grants totaled approximately $14.8 million, but this total was reduced to less than $500,000 when the team adjusted for system discrepancies associated with the State Home Construction and Veterans Cemetery Grants Programs. For fiscal year 2020, the estimated budgets for the grant programs covered in this risk assessment totaled approximately $2.27 billion, or only about 1.03 percent of VA’s overall budget estimate of $221 billion. Moreover, VA’s largest grant program, State Home Per Diem, obligates funds at the time an invoice is paid. As a result, for about 67 percent of the $2.27 billion grant budget, VA has implemented a process to mitigate the risk of undisbursed balances that can tie up funds for other uses. The team concluded that an overall audit or review of the timely closeout of grants is not warranted at this time.

Medicare Part B covers dialysis services for beneficiaries with end-stage renal disease (ESRD). Prior OIG reviews identified inappropriate Medicare payments made for ESRD (dialysis) services that were medically unnecessary, not properly ordered, undocumented, or did not comply with Medicare consolidated billing requirements.

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