Federal Reports

This healthcare inspection assessed allegations that over a multi-year period, providers at three facilities ordered or continued to order a high dose of an antidepressant medication amitriptyline for a patient who was not told about the risks of the high dose, and was experiencing some side effects associated with the medication. Additionally, when asked about attempts to reduce the dose of the patient’s medication, the VA Illiana Health Care System (system) in Danville, Illinois, provided Senator Joe Donnelly inaccurate information. The Office of Inspector General (OIG) substantiated VA providers did not explain to the patient that the amitriptyline dosing was higher than the drug labeling for outpatients or the risks of the high dosage during the period of care from 2012 through mid-2018. In 2012, a provider at the Orlando VA Medical Center (VAMC) in Florida ordered an electrocardiogram but did not inform the patient about an abnormality or discuss the potential that the high dose of amitriptyline contributed to the abnormality. At another VAMC in Indianapolis, Indiana, the ordering provider did not notify the patient that 2016 test results indicated a subtherapeutic level of amitriptyline. At the system, there was no follow-up to the patient’s expressed cardiac concerns due to a failed collaboration between the system’s treating psychiatrist and a primary care provider. Due to other potential causes, the OIG was unable to substantiate the patient experienced tachycardia or short-term memory loss because of taking amitriptyline. The system’s response to Senator Donnelly was not timely and included inaccurate information. The OIG made eight recommendations related to evaluations of the patient’s cardiac care, patient notification of electrocardiograms and blood tests, the strengthening of system processes for effective clinical consultation between providers and congressional inquiry responses, and an evaluation of system staff actions in preparation of the letter to Senator Donnelly.

Although the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), has made significant progress in the timely resolution of audit recommendations since our previous review (of Federal fiscal years (FYs) 2006 and 2007), CMS did not always resolve audit recommendations in a timely manner during FYs 2015 and 2016. Specifically, CMS resolved 1,231 of the 1,371 recommendations that were outstanding during FYs 2015 and 2016. However, it did not resolve 405 of the 1,231 recommendations (32.9 percent) within the required 6-month resolution period. In addition, as of September 30, 2016, CMS had not resolved 140 audit recommendations that were past due for resolution. Some of the past-due recommendations had associated dollar amounts that totaled $138.6 million; others were procedural in nature.

The unclassified version of the SAR covers the period from April 1, 2018, through September 30, 2018, and reflects what NSA OIG could release publicly about its work for that reporting period. The OIG issued 21 reports and oversight memoranda during that period, making 620 recommendations to assist the Agency in addressing the findings and deficiencies identified. NSA’s management agreed with all OIG recommendations made during this period. The Director of the NSA and Congress previously received the classified version of the SAR in accordance with the IG Act.

Some of the bonus payments that Virginia received for the audit period were not allowable in accordance with Federal requirements. Most of the data used in Virginia's bonus payment calculations were in accordance with Federal requirements. However, Virginia overstated its current enrollments in its bonus requests to the Centers for Medicare & Medicaid Services (CMS) for fiscal years (FYs) 2011 through 2013 because it improperly inflated its current enrollment by a fixed percentage estimate, to account for potential retroactive enrollment, instead of using actual enrollment and the adjustment process to account for actual retroactive enrollment. CMS guidance instructed Virginia to calculate current enrollment based on actual enrollment.

U.S. Department of Labor Office of Inspector General's investigations newsletter for the period of October 1 – November 30, 2018.